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Download A Healthful Approach to Easing Those Aches and Pains
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AHealthfulApproachtoEasing ThoseAchesandPains MarcNowak,PT DirectorofAthleteWellness USRowingAssociation 2WallStreet Princeton,NJ08540 [email protected] CommonDriversofLumbopelvicandHipDysfunction intheRowingAthlete: EffectsofMusculoskeletalDysfunctionontheRowingStroke InabilitytoSmoothlygettotheCatchPhaseoftheRowingStroke andTransitionintotheDrivePhasewithProperStabilityandPosition EffectsofMusculoskeletalDysfunctionontheRowingStroke InabilitytomaintainCoreStabilityandPositionthroughouttheDrivePhase EffectsofMusculoskeletalDysfunctionontheRowingStroke InabilitytomaintaingoodCoreStabilityandPositionattheFinishand SmoothlyTransitionintotheRecoveryPhaseoftheStroke CommonDriversofLumbopelvicandHipDysfunction intheRowingAthlete: • RestrictionofLumbarSpineJointandSoftTissueMobility– Flexion and/orExtension • LumbopelvicInstability • PelvicObliquity • StructuralLegLengthDiscrepancy • HipAnterior/PosteriorCapsularRestrictions • HipJointInstability • GlutealWeaknessvsHypertonicity(Restriction>Spasm>Weakness) • Oblique– Rectus- TransverseAbdominalWeakness– Spasm– Restriction • CoreStrengthandEnduranceDeficits AnteriorPelvicObliquity TAUT:ErectorSpinae– Iliopsoas– RectusFemoris – TFL– IT Band WEAK:Rectus/ObliqueAbdominals– Gluteals - Hamstrings AnteriorPelvicObliquity • • • • • • • • • • • • • LumbarLordosis– Increasedtooneorbothsides DecreasedLumbarFlexionandSideBendingtotheOppositeSide IncreasedHipFlexion– Adduction– IR– inStance IncreasedKneeFlexionMomentinGait IncreasedGenuValgum LateralPatellofemoraljointposition IncreasedStresstoMedialPFjointandSoftTissueStructures IncreasedITBandTensionattheLateralHipandKnee IncreasedPosteriorProximalTibio-FibularJointPosteriorPosition IncreasedPeronealNerveTensionattheKnee IncreasedSub-Talar JointPronation IncreasedGastrocsoleus MuscleTightness DisplayedontheRightSidein80-90%ofScreenedJuniorRowers PosteriorPelvicObliquity PosteriorPelvicObliquity PosteriorPelvicObliquity • LumbarLordosis– Decreasedtooneorbothsides • DecreasedLumbarExtensionandSideBendingtotheSameSide • IncreasedLumbarFlexionandStresstoPosteriorSpineLigaments andDisc– Standing– Squatting- Sitting • IncreasedHipExtension– Abduction– ER– inStance • IncreasedHipExtensionMomentinGait • IncreasedGenuVarum • MedialPatellofemoraljointposition • IncreasedStresstoLateralKneeJointandSoftTissueStructures • IncreasedHamstringTensionattheLumbarSpine,Hip,andKnee • IncreasedSub-Talar JointSupination • IncreasedMedialGastrocsoleus MuscleTightness • DisplayedontheLeftSidein80-90%ofScreenedJuniorRowers EndRangeHipFlexion RequiresNormalandUnrestricted • LumbarSpineFlexion • PelvicPosteriorRotation • PosteriorHipCapsuleandSoftTissueMobility EndRangeHipExtension RequiresNormalandUnrestricted • LumbarSpineExtension • AnteriorPelvicRotation • AnteriorHipCapsularJointandSoftTissueMobility AnteriorandPosteriorPelvicObliquity • BotharePresentintheRowingAthlete • SweepRowing– OutsideArm/Leg– PosteriorRotation • SweepRowing– InsideArm/Leg– AnteriorRotation • Sculling– DominantSide– AnteriorRotation– (Right) • Sculling– Non-DominantSide– PosteriorRotation– (Left) • FunctionalRightThoracicandLeftLumbarScoliosis • CommoninJuniortoMastersRowing MastersRower ThoracolumbarSpine– PelvicDysfunction Hip- Knee- Back- Dysfunction PromotedbyLimitationinAnkleDorsiflexion TransitionsinRowingTraining • Shouldbelimitedinthefirst2-3weekstoavoidoverstressing restrictedjointandsofttissuestructurestoallowforstructural changesandthebody’snaturalcompensatorymechanismsto develop– LimitHeavyLoadsandHighVolume • AtLeastTwoWeeksofaTransitionalProgramshouldbe encouragedwithanychangesinRowingPositionortraining Device: Erg><Row– Erg><Scull– Sweep><Scull– Port><Starboard • TransitionalProgram– EmphasizeHigherRates– LowerVolume • TraditionallynotdoneinCollegiateTrainingTrips– U23/Junior NationalTeamPrograms– JuniorSummerClubProgramsand ScullingCamps– OftenatimewhenAcuteInjuryOccurs ØMusculoskeletalDysfunctionwillnotdecreasewithabsenceof trainingunlessitisinconjunctionwithrehabilitation BenefitsofDynamicCoreMobilizationandStabilization Exercises • • • • • • MentalFocusandConcentration DynamicFlexibilityTraining CoreStabilization Strengthening Balance/Proprioception InjuryPreventionandRecovery MentalFocusandConcentration • FOCUS:Lettingthemindbecomeabsorbedinan activityandthesubtlebodychangestheactivity produces • Processofdevelopingamentalimageofanactivity andthekineticawarenesstoperformit BREATHE…Consciousbreathing: • Reducesdistractions • Improvesfocusandformoftheexercisetechnique • Slowsdowntheactivity • Releasesemotionalandphysicaltension • EXHALEwithExertion • INHALEwithRecovery DynamicFlexibilityTraining • Controlledtransitions between posturestoendrangesof motion • Gently increaseflexibility throughthefunctional movementpatternsinall3 planesofmotion • Holdagonistmusclegroups in isometriccontractionwhile stretchingandrelaxingthe antagonistmuscles • Increasesbodytemperature, lubricatesthejoints,andwarms themuscles CoreStabilization Slowfocusedmovement patternsrequireastrongcore Corestrengthisrequiredand developedthroughtheability to: • Sustainprolongedpostures • Smoothlytransitionbetween postures • Maintainbalancewhenthelarge musclegroupsbecomefatigued Strengthening • Bodyweightprovidestheresistance • Allposturesareclosedchainedthroughone limboranother • Neuromuscularcontrolischallengedand improvedinmultiplemusclegroups simultaneously • Challengesthemusclestosustainaposture, transitionslowlyandwithcontrolbetween positions • Isometric,concentric,andeccentricmuscle contractionsareusedsimultaneously throughouttheexercise BalanceandProprioception (AwarenessofBodyPositioninSpace) • Thelowerextremitiesandcoremuscles providethesupportfortheupperbody tostandwithstrengthandmovefluidly • Balanceposturesandactivitiesarean effectivewaytoaddressmuscle imbalancescreatedbyrepetitive overuseactivitiesinsportsandwork • Theyrequirementalfocus,bodycontrol, breathing,andmindfulnessto successfullyperformdynamic mobilization/stabilizationactivities correctly InjuryPreventionandRecovery • Knowledgeofthebiomechanicsofa specificsport,recreationalactivity,or occupationisvitalforthedevelopmentof preventionandrehabilitationprograms • Rowing:Anteriortrunk,shoulder,hip,and thoraciccagemobilityforprotectionof thelumbarspineandribsinrowers • Rowing:Posteriortrunk,hip,scapular, andcorestrengthtoprotectthelumbar spineandribsinrowers • DynamicExercisesExpose – Tightness, weakness,imbalance,dysfunction,and pain Warm-UpandDynamicStabilityTraining Pre-TrainingExercises • Warm-up:Bike- Jog- Ellipticaltrainer- ergetc. • 10minutes- Increasecorebodytemperature– Sweating • Add5MinutesWarm-Upforevery10degree dropintemperature DynamicTrainingCombines: • Forward/sidewaysbodymotion • Balance/coordination • Flexibility • CoreStability • Preparesthebodyforsportstraining • Takes10-15minutesbeforepractice • “InjuryPrevention” • “FIFA11”andPEPPrograms • TranslatestoRowing“?” CoolDownRecoveryFlexibilityExercises Post-TrainingExercises Yoga: • Staticpositiondynamicstretching • Stretchesmanybodypartswithasinglepose • Combinesbalanceandcorestabilitywith flexibility Staticstretching: • Passivestretchtoisolatedmusclegroupsin staticpositions • Bothrestoremuscle,connectivetissue,and jointstotheirnormallengthaftertraining • Graduallylowersheartrate • Preparesthebodyforthenextpractice Warm-UpProgram#1 4-6Exercises– CoffeefortheMusculoskeletalsystem DynamicStabilizationExercises: • Walk/JogwithArmCircles • KneeHugLunges • StraightLegMarch • LegCradle CoreStabilizationExercises: • SquatswithFeetApart- ToesIn • SquatswithFeetTogether Warm-Up Program #1: Dynamic Stabilization Exercises Walk/JogwithArmCircles 2x30Feet Warm-Up Program #1: Dynamic Stabilization Exercises KneeHugLunges 2x30Feet Warm-Up Program #1: Dynamic Stabilization Exercises StraightLegMarch 2x30Feet Warm-Up Program #1: Dynamic Stabilization Exercises LegCradle 2x30Feet Warm-Up Program #1: Core Stabilization Exercises SquatswithFeetApart- Toesin 1min Warm-Up Program #1: Core Stabilization Exercises SquatswithFeetTogether 1min CoolDownProgram#1 4-6exercises– TeatoRelaxtheMusclesafterWork CoreMobilityExercises: • SupineHip/TrunkRotation– Kneestogether • SupineHip/TrunkRotation– Kneesapart YogaExercises: • UpwardDogPose • Warrior1PosewithTrunkExtension DynamicStabilizationExercises: • SidewaysLunge • ForwardBend– AlternatingToeTouch Cool Down Program #1: Core Mobility Exercises SupineHip/TrunkRotation- Kneestogether 1min Cool Down Program #1: Core Mobility Exercises SupineHip/TrunkRotation- Kneesapart 1min Cool Down Program #1: Static Stretching Exercises UpwardDogPose 6x6sec Cool Down Program #1: Yoga Exercises Warrior1PosewithTrunkExtension 2-3x15seceachside Cool Down Program #1: Dynamic Stabilization Exercises SidewaysLunge 2x30feet Cool Down Program #1: Dynamic Stabilization Exercises ForwardBend– AlternatingToeTouch 2x30feet
