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