Written by Team Juggernaut
Prehab and Mobility Drills to Promote Longevity
Earlier this month in our article on Prehab and Mobility part I, we explored the importance of achieving general physical preparedness (GPP) before engaging in any sports performance training. Many exercises that can be executed as GPP exercises are by nature prehabilitative/rehabilitative exercises as well. Whether you are preparing for elite sports performance or coming off of an injury and getting back to 100%, the 4 exercises that we will be exploring in this article address 4 key deficiencies that are common amongst athletes. The preemptive or preventative approach is something that we all nod our heads to because we get the concept of taking action before an injury occurs. The same approach can be applied to performance training. If you expect to run fast, jump high, throw far and/or perform for 2 straight hours, you better be sure to take preemptive measures to ensure you can complete your desired task. Again the proverbial agreeing nod is always seen when we preach this to our athletes and patients. Below are the 4 most common deficiencies that we see in athletes of all sport type. These deficiencies can be corrected for performance gains in training and in your sport, and even more importantly the injuries manifested out of these deficiencies can be decreased significantly.
Scapular Positioning/Mechanics –
Scapular Positioning is the root of all Glenohumeral pathology. Sure throwing a 100+ pitch game, overhead snatching (for reps) or even worse, falling onto an outstretched arm can cause injury to the shoulder, but even within those type of injuries lies the scapular mechanics that lead to the imbalances that eventually caused the bicipital tendonitis, impingement syndrome or labral pathology (tear, fraying, degeneration). Furthermore, if the lifter lacks scapular positioning, they will struggle to achieve a proper bench or squat setup, due to their inability to create a good shelf for the bar to sit on in the squat or tight base to lay on as they press. So what is proper mechanics? Proper mechanics can be defined, in my opinion, as the absence of as many abnormalities as possible. Biologic variability from one athlete to the next will lead us to structural and physiologic limitations that prevent us from stating things such as “The scapula will initiate movement at exactly 15° of GH abduction with limitations in protraction and inferior border flaring utilizing pure upward rotation with slight depression at end range abduction.” This is how a shoulder should move, (for abduction) if it doesn’t it can be called a SICK scapula S- Scapular mal positioning, I- Inferior medial border flaring, C- Coracoid tenderness and K- scapular dysKinesis. We elaborate on the acronym and add a ME component, M- Medial border winging and E- scapular Elevation. ME SICK. Without going into a full article on the shoulder and biomechanics, it is accurate to say that as you correct each of these components of a ME SICK scapula the other defining abnormalities begin to functionally correct themselves. This is why we utilize the Scapular retraction and depression exercise, which you can see in our prehab/mobility video associated with this article. Training the shoulder girdle to perform from this posture will ultimately ensure safer training and allow you to have performance gains.
Femoral Acetabular Capsule Tightness –
Hip pain and tightness in athletic positions where the Femoral acetabular joint is at an angle of < 90° is most functionally most commonly due to a tight hip capsule. Tight and painful hips will make it very difficult for an athlete or lifter to squat to/below parallel or get into proper position to begin a deadlift. Like with all injuries or abnormalities it is important to rule out underlying structural pathology. A number of us will have bony structural limitations due to CAM, Pincer or both Femoral Acetabular Impingement (FAI) syndromes; others of us will have femoral neck angles that cause retroversion or anteversion. These are conditions that need clinical diagnosis and imaging and should be assumed if a conservative approach to correcting the “pain or tightness” does not work. A common functional cause of biomechanical tightness or pain in the hip at smaller angles as the hip is flexed is due to posterior hip capsule tightness. This is easily diagnosed with a simple range of motion test of bilateral femoral acetabular internal rotation. Asymmetrical IR demonstrates a tight posterior hip capsule on the decreased range side. The capsule becomes tight and drives the femoral head anteriorly into the acetabulum. As the spherical head of the femur rolls and glides in the acetabulum its anteriorly imposed position causes acetabular rim engagement which can lead to a sharp pain from bone to bone contact (in severe cases) or a tight pinching feeling in mild to moderate cases of capsular tightness. The goal of hip mobilization is to first depress the joint with axial traction and then go through a full range of hip flexion with internal rotation. In the prehab/mobility video you will see this performed. A higher success rate in hip mobilization can be utilized with practitioner-applied mobilization with movement where an anterior to posterior component is utilized to further stretch the posterior capsule.
Ankle Dorsiflexion Mortise Mechanics –
The ability for the ankle to dorsiflex has major implications for knee and hip mechanics. There is also a huge force transmission component that is associated with this link in the chain. Lack of ankle mobility will cause the athlete to shift their weight onto their toes as they descend in a squat, thus limiting their ability to engage their musculature of the posterior chain and increasing stress on the patella tendons. Dorsiflexion of the ankle is essentially centered on one bone in your foot, the talus. The talus has an articulation with the calcaneus at its base and the navicular at its anterior. The talus has a dome shaped superior portion that serves as the articular surface with the tibia and fibula of the lower leg creating a mortise joint. A normal ankle should have the capacity to dorsiflex up to 25-35°, limitation in this range exponentially increases the changes that occur up the anatomical chain. Normal kinematics of the mortise joint in a closed chain position (which is a debatable concept for another time) is at its simplest explanation an anterior rolling motion of the articular surfaces of the tibia and fibula on the dome of the talus. Often times with decreases in ankle dorsiflexion tight posterior musculature are the cause. However the talar dome can be the cause of limited motion as well. The problem with lack of dorsiflexion is that there are often times no subjective manifestations of this biomechanical error! Some people will over time complain of plantar fasciitis, anterior ankle pain or medial foot pain.
Typically this is an abnormality that needs to be seen objectively in a squat assessment, or lunge maneuver. To spare the evolution of this becoming a lower extremity assessment/biomechanics lesson lets just explore what changes are made with a decrease in ankle dorsiflexion and how it can generally be addressed. If a sporting demand requires the base of an athlete (foot/ankle) to achieve that 25-35° the body will get what it wants. If dorsiflexion is not possible 1 of 2 things happened 1- catastrophic injury such as talar dome fracture, or Achilles tendon rupture. 2- the body compensates and achieves it through compensatory movement. The 3 main compensatory movements that will occur are whole foot pronation, knee valgus collapse, and hip internal rotation. For terrestrial athletes not good things if your squatting, lunging or on the field of play single leg load bearing. The generalized approach from a mobility standpoint is shown in the prehab/mobility video where we attempt to translate the talus posteriorly to allow more surface articulation and a greater range of motion for the tibia and fibula.
Pelvic Positioning/Mechanics –
The topic of “core strength,” “strong abs,” etc.… is far from a myth it unfortunately is looked at in a very poor light. Of course we want rock hard washboards but the reality is that the function of our “core” has very little to do with how we traditionally have trained our core. Lumbopelvic mechanics are truly the most important mechanics in the body and fortunately it is the simplest to train. A common problem among lifters is posterior pelvic tilt, or the loss of low back arch when the hips rotate under the body, this is detrimental to both low back health and maximal lifting ability. Posterior pelvic tilt is a symptom of poor pelvic positioning. From a preventative injury point of view we want to have tensegrity amongst our abdominal musculature as well as posterior chain musculature including the hamstrings. The ability to achieve tensegrity, which is equal and opposite tensile strength in all directions of any associated muscles involved in lumbopelvic motion. As the Lumbar spine and Sacroiliac joints are held relatively stable the hip should perform its diarthrodial motions we need it to. In this manner we spare injuring tissues in the lumbopelvic region by reducing rotatory and shearing forces. From a sports performance point of view the core is important to transmit forces produced by the body from one end of the chain to the other, or from one side of the chain to the other as illustrated by gait. Now of course it is very black and white to assume the spine and pelvis do not move and only the femoral acetabular articulation creates motion, but the fact that it is further from that mechanical picture then it is similar is a problem. This brings us to the utilization of a very rudimentary sequence of neurologic control. Pelvic tilting to achieve a neutral lumbopelvic positioning is a very important piece of the prevention performance paradigm. Secondly achieving pure hip hinging with a neutral lumbopelvic alignment is the next step. The 3rd step is to stress the structures by implementing asymmetrical weight and dependence on one extremity. This sequence of neurologic education is vital in the preparation to sports performance and injury prevention.
Even though the following 4 deficiencies are characteristic of most athletes, it may not be true of you. It is always important to seek a professional consultation with a specialist in the field of sports performance. The following exercises are generalized but when implemented for an individual with the associated deficiency, performance gains and breakthroughs in rehabilitation will be seen.