The Plan for Weeks 1 & 2

Week 1
Lecture 1- Module Guide, Being Critical, Corrective Exercise Lecture
Practical 1- Practice AAA/ FMS

Week 2
- Merge the lecture and practical
By the end of the session you will have developed a presentation that covers the following points:

• Reason/ rationale for screening test(s) focused on

• Conduct of the test
• Identification of issues
• Long term corrective exercise strategies
 Types of answer in essays
Statements of
fact…
Knowledge
E.g. The height of a
badminton net for an official
competition is 5ft at the
centre and 5ft 1in at the poles
E.g. The action of knee flexion
produced by the hamstrings is
an example of a third class
lever
Statements of Statements of
preference… reason…
Opinion Judgement
E.g. Based on the current
E.g. Norwich City have the
evidence KT tape is effective
worst kit in English football
in injury management
E.g. Truro cricket ground is
E.g. Current research suggests
one of the most beautiful
that isotonic drinks are no
cricket locations in the
better than water
country
hiit training boxing fat
What is Critical Thinking?

Asking Questions

Weighing
Information
Critical Thinking is:
Establishing
Assumptions

Making reasonable
judgments
 HIT v SIT - Contradictions
The study concluded that 4-min intervals resulted in the greatest enhancement of
performance in a 40-km time trial. This is in accordance with the principle of specificity, as the
40-km time-trial was performed at an average intensity of approximately 80% of PP (or ~90%
of VO2max).

However, the 30 second SIT group also displayed significant performance improvements
contradicting that principle. Ross and Leveritt (2001) suggest that following SIT the activity of
glycolytic enzymes, such as phosphofructokinase increases…(Cadefau et al., 1990). These
adaptations can lead to enhanced fatigue resistance by altering skeletal muscle buffering
capacity (Nevil et al., 1989).

This would account for the apparent contradiction to the theory of specificity mentioned by
Stepto.
HIT v SIT- Problems with method
1. Although interesting, it could be suggested that the ecological value of this study is
limited as the results were based on a 5km time trial (a distance seldom raced by cyclists)
rather than a 40km time trial.

2. Creer hypothesised that his improved neuromuscular efficiency may have delayed the
onset of fatigue. Despite more research being needed in this area, reproducing this study
would be difficult as the number of sprints completed in each session was not stated.
Coaching practice - disagreements
A further facet of constructivist learning is Mosston & Ashworth’s (1990) principle of
Guided Discovery where by learners are required to problem solve in order to discover
(with guidance) the best (predetermined) technique or solution…..

There are critics of this method of learning. Hardiman, Pollatsek, and Weil (1986) and
Brown and Campione (1994) noted that when students learn science in classrooms with
“discovery methods”, they often become lost and frustrated,
 Corrective Exercise Training
1. Identify the problem – (assessment)
• Special tests, FMS or AAA.

2. Solve the problem- (corrective programme design)

• Strength, flexibility or neuromuscular control.

3. Implement the solution – (train)

 Why screen?
Foundation movements typically involve:
–variations of squatting, lunging, jumping, pushing, pulling and bracing

Strong foundations in a diverse range of athletic qualities

–tolerate progressive training & competitive demands of sport

(Cook et al. 2006, Giles, 2011)

 Three tier baseline testing models
Functional movement quality
- Basic fundamental movements that demonstrate full range of motion, body
control, balance and basic stability.

Functional performance quantity

- General non-specific performance demonstrating gross power, speed endurance
and agility.

Sport-specific skills
- Skills demonstrating sport-specific movement patterns
 Example with just “performance quantity”
• Two rugby players
• Testing shows both have similar 10m/ 40m sprint times
• All times were considered poor

What do they need to do?

Both should focus on basic speed and plyometric development

However….
Player 1 shows good flexibility, stability and balance whilst player 2 does not.
How would you adjust your recommendations?

Player 1 = Basic speed and plyometrics

Player 2 = Basic mobility + stability. Then progress to speed/plyos
Each level builds on a foundation of the next.
 What issues
What are the
will a screen
causes?
indicate?
(Suggested these can be
in 3 broad categories).
Cumulative Injury Cycle
Causes of imbalances
Static Malalignments (poor posture)

→ Altered reciprocal inhibition.

→ GTOs detect tension in muscle rectus femoris

→ Message sent to inhibit hamstrings.

Leads to dynamic malalignments
Patterns of inter muscle coordination are disturbed leading to over
reliance on synergists.

→ Dysfunction at joints.

→ Plantar fasciitis, posterior tibialis tendonitis (shin splints), knee

pain and lower back pain.
Detection of imbalances:
 Is the FMS a reliable test?
Reliability describes whether a test can be repeated either:

– by the same person at a different time (intra-rater)

– by different people at the same time (inter-rater)
– BUT produce the same result.
Is the FMS a valid test?
• Validity describes whether a test actually measures solely what it is
setting out to measure.

• The purpose of the FMS is to identify compensation patterns as they

are performed in sport.
⁻ But how are the tests performed?
Can FMS score predict
injury risk?
FMS measures prevalence of compensation patterns
–thought to be injurious.

Relative risk with an FMS score of:

– ≤14 points being injured

4 studies found that the FMS could not predict

injury risk.

7 studies, the relative risk was between 1.65 – 11.67

times
–suggests FMS may well differentiate between
greater or lesser risk of injury
Athletic Ability Test
Athletic Ability Assessment

Not to be used as a clearance screen in order to begin training safely

–Unlike FMS

An assessment methodology to be used as athletes progress:

–Through sporting career
–require increased movement competency

–Work under load & under greater levels of movement complexity.

NASM Corrective Exercise Continuum
 Myofascial release

CREASES R
ANG E
R E LE A S E IN
S LF -M YOFASCIAL
IN MUSCLE
E
AN ACUTE BOUT
O F
S UBSEQUENT
DEC R E A SE

OF MOTION
W IT HO U T A

ACTIVATIO N OR F O RCE
,M E. M ,A L. C
ICHELLE
,
ULLALEY
MANDA
UCONATO

EL D.H. P ada
ENNEY
land, Can
D LD, MICHA BUTTON hn’s, Newfound
GRAHAM Z. M , AND DUANE C. d, St. Jo
AC ON A
D ID G. BEHM ersity of Newfoundlan
COREY D.J. DRA
KE , AV
Memorial Univ
an Kinetics and Recreation,
School of hum
 Lengthening Techniques

Static stretching PNF Stretching Mobility training Integrated/ end range

exercise
Activation Techniques

Positional Isometrics
(abductors)

Positional Isometrics Isolated Strengthening Isolated Strengthening

(rotator cuffs) (gluteals) (adductors)
Integration techniques
Critique the CEC:
Real world issues
Can’t squat or won’t squat?
• Improve your coaching/ cueing
&
Big Mo!
• Stop everything- your hips are wonky!
 Evaluation of dysfunction during a Single
Leg Squat.
- Provide a rationale for the use of a screening test(s) for a hypothetical
athlete or for a sport in general.
- Suggest hypothetical issues that could be found
- the underpinning mechanisms.
- Suggest training methods to correct suggested problems.
Single Leg Squat (SLS) Rationale
The SLS test is a simple screening tool
that can be used for physical
examinations to screen for athletes
with poor knee control.
Ugalde et al., (2015)

Knee motion and knee loading are

predictors of cruciate ligament injury • Unilateral
risk. • Hip/ Knee/ Ankle extension
• Motor control
Hewett et al., (2005) • Load knee extensors
Single Leg Squat
• Maintains perfect trunk
posture.

• Perfect alignment and control

of hip/knee/ankle

• Hip below knee (below parallel)

while maintaining neutral
spine.
Can’t squat or won’t squat?
Component Test
Prone Hold
Strength
Side Hold
Pectorals length special test
Flexibility
Trunk Angle Shoulder flexion wall test
Corrrection through cues.
Neuromuscular
Performance of other
Control
exercises with neutral spine

Strength Single leg fwd hop

Thomas Test
Hip/ Knee/ Flexibility 120° with bent knee
Ankle
Alignment Dorsi flexion test
Corrrection through cues.
Neuromuscular
Performance of basic
Control
exercise with alignment

Strength Single leg fwd hop

Thomas Test
Flexibility 120° with bent knee
Depth
Dorsi flexion test
Corrrection through cues.
Neuromuscular
Performance of basic
Control
exercises with alignment
 Chin Poke
• Compensating for kyphosis

Kyphotic thoracic spine

• Flexed lifestyle
• Weak trapezius
• Weak scapulae

General collapse of torso

• Poor lumbo-pelvic control
• Weak TVA
• Weak obliques

Evaluation of movement
Mechanisms - Kyphosis
Muyor, Lopez-Minarro and Alacid (2011)
A comparison of the thoracic spine in the sagittal plane between elite cyclists and non-
athlete subjects

• The cyclist group had significantly higher thoracic spine angles than the control group
• Prolonged training sessions lead to adaptations in the spinal structures which result in increased
vertebral stress and intra-disc pressure.
• Inadequate standing postural awareness

Dastmanesh et al., (2013)

• Strength of erector spinae

• Strength of scapular adductors
• Decreased flexibility in trunk flexors
• Decreased flexibility in scapular abductors
 Mechanisms – Collapse of torso
“Core stability” is the ability of the lumbopelvic hip complex to prevent buckling and to return to equilibrium after
perturbation.

• Hip and trunk muscle stiffness.

• Intra-abdominal pressure
• Spinal compressive forces.
• (Increased spine compression by 21%
leading to improved spinal stability).

Diaphragm and pelvic floor

TVA, multifidus and QL
Rectus abdominus
Int and ext obliques
Hip adductors and abductors flexors and extensors

(Wilson, Ireland and Davis 2005)

Evaluation of
movement

Hips above parallel

• Poor hip mobility
• Poor dorsi flexion

Heel lift
• Weight on front of foot
• Poor dorsi flexion
Depth
Schoenfeld (2010)

• Significant strength and mobility is required at the ankle for proper squat performance.

• Poor hip joint mobility can lead to greater forward lean.

Kritz et al., (2009)

• Ankle mobility is critical to ensure a balanced and controlled motion.

• Stiffness in the ankle joint cause the knee joints to compensate have negative implications on stability
required for efficient mobility
Evaluation of movement

Tilted Pelvis (Hip Hitch)

• Weak Gluteus Medius
• Transfer of centre of gravity towards
standing leg

Knee Valgus and

Int Rot of Femur
• Weak Gluteus Medius
• Poor dorsi flection
 Mechanisms – Hip Hitch
Crossley et al., (2011)
• The “good” performers (SLS) exhibited greater hip abduction torque and trunk side flexion force than
those deemed “poor”.
• Single-leg squat task is a reliable tool that may be used to identify people with hip muscle dysfunction.

Nakagawa et al., (2012)

• Measured trunk lean, SLS performance and glute med strength.
• The findings consistent with the concept that trunk lean may act as a compensatory mechanism for hip abductor
weakness.

DiMattia et al., (2005)

• No correlation between hip-abduction strength in frontal-plane and SLS.
• SLS test in screening hip-abductor strength is limited. The origin of observable deficits during SLS
requires further objective assessment.
Mechanisms – Knee valgus
Claiborne et al., (2006)
• Greater peak torque during hip abduction, knee flexion and knee extension = less motion in the valgus
direction.
• Concluding that quadriceps, hamstring and gluteal strength stabilised the knee joint.

Bell et al., (2008)

• Decreased plantarflexion strength was a significant predictor of knee valgus.
• Gastrocnemius acts as a dynamic knee stabilizer reducing knee frontal plane movement.
• Hip muscle did not appear to be a contributing to excessive knee valgus.
The mechanical consequences of dynamic frontal plane limb alignment for non-contact
ACL injury.
Chaudhari and Andriacchi (2004)

Investigated the maximum sustainable axial force (Fmax) that the limb tolerated before reaching threshold
for ACL injury (opening by 8°).

From neutral position: 5.1 BW

From valgus position: 2.2 BW
(Force during running is 2.5 BW (Keller 2006))

Thus, dynamic knee valgus motion is often theorized as a risk factor for acute knee injuries.
Evaluation of movement

Asymmetrical compared with other

left

General Instability &

lack of control
• Poor motor control
• Poor strength

Pronation
 Component Test Corrective Exercises 1 Corrective Exercises 2
Prone Hold Prone Hold Diagonal trunk rotation
Strength
Side Hold Side Hold Cross body motion
Pectorals length special test PNF stretching. Multi planar lunges
Flexibility
Trunk Angle Shoulder flexion wall test Thoracic Mobility Exercises. with arm drivers
Corrrection through cues. Single Arm Row Bent over row
Neuromuscular
Performance of other Goblet squat Deadlift
Control
exercises with neutral spine

"Clam" & Abduction

Calf Raises Lunge
Strength Single leg fwd hop
Leg Press Step Up
Leg Extension/ Curl
Hip/ Knee/ Thomas Test PNF stretching.
Ankle Multi planar lunges- different
Alignment Flexibility 120° with bent knee Hip Mobility
ranges.
Dorsi flexion test Ankle mobility
Corrrection through cues. Lunges
Neuromuscular Leg Press
Performance of basic Jumps
Control Goblet Squat
exercise with alignment Hop and Stick

Leg Press Lunge

Strength Single leg fwd hop
Goblet Squat Step Up
Thomas Test PNF stretching.
Multi planar lunges- different
Flexibility 120° with bent knee Hip Mobility
Depth ranges.
Dorsi flexion test Ankle mobility
Corrrection through cues.
Neuromuscular Box Squat Lunge
Performance of basic
Control Squat Split Squat
exercises with alignment
Global Corrections
1
Box Squat
Global Corrections
2
Lunges
Global Corrections
3
Raised Leg Split Squat
Global Corrections
4
Assisted SLS
Global Corrections
5
Weighted SLS
Global Corrections
SLS
 Week 2: By the end of the session you will have developed a presentation that covers the following points:

• Reason/ rationale for screening test(s) focused on

• Conduct of the test

• Identification of issues

• Causes of issues via other tests -

• Skill (neuromuscular)
• Flexibility
• Strength

• Mechanisms

• Long term corrective exercise strategies (Specific exercises and global movements) for 3 phases.
References
Bell, D. R., Padua, D. A., & Clark, M. A. (2008). Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement. Archives of
physical medicine and rehabilitation, 89(7), 1323-1328.

Chaudhari, A. M., & Andriacchi, T. P. (2006). The mechanical consequences of dynamic frontal plane limb alignment for non-contact ACL injury. Journal of
biomechanics, 39(2), 330-338.

Claiborne, T. L., Armstrong, C. W., Gandhi, V., & Pincivero, D. M. (2006). Relationship between hip and knee strength and knee valgus during a single leg
squat. Journal of applied biomechanics, 22(1), 41-50.

Clark, M., & Lucett, S. (Eds.). (2010). NASM essentials of corrective exercise training. Lippincott Williams & Wilkins.

Crossley, K. M., Zhang, W. J., Schache, A. G., Bryant, A., & Cowan, S. M. (2011). Performance on the single-leg squat task indicates hip abductor muscle
function. The American journal of sports medicine, 39(4), 866-873.

Dastmanesh, S., Eskandari, E., & Shafiee, G. H. (2013). Relationship Between Physical Fitness Abilities, Trunk Range of Motion and Kyphosis in Junior High School
Students. Middle-East Journal of Scientific Research, 13(1), 79-84.

Harvey, D. (1998). Assessment of the flexibility of elite athletes using the modified Thomas test. British Journal of Sports Medicine, 32(1), 68-70.

Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., ... & Succop, P. (2005). Biomechanical measures of neuromuscular control and
valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes a prospective study. The American journal of sports medicine, 33(4), 492-501.

Kritz, M., Cronin, J., & Hume, P. (2009). The bodyweight squat: A movement screen for the squat pattern. Strength & Conditioning Journal, 31(1), 76-85.
References cont.
Lewis, J. S., & Valentine, R. E. (2007). The pectoralis minor length test: a study of the intra-rater reliability and diagnostic accuracy in subjects with
and without shoulder symptoms. BMC musculoskeletal disorders, 8(1), 64.

McKeown, I., Taylor‐McKeown, K., Woods, C., & Ball, N. (2014). Athletic ability assessment: a movement assessment protocol for
athletes. International journal of sports physical therapy, 9(7), 862.

Muyor, J. M., López-Miñarro, P. A., & Alacid, F. (2011). A comparison of the thoracic spine in the sagittal plane between elite cyclists and non-
athlete subjects. Journal of back and musculoskeletal rehabilitation, 24(3), 129-135.

Nakagawa, T. H., Moriya, E. T., Maciel, C. D., & Serrao, F. V. (2012). Trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle
activation during a single-leg squat in males and females with and without patellofemoral pain syndrome. journal of orthopaedic & sports physical
therapy, 42(6), 491-501.

Ugalde, V., Brockman, C., Bailowitz, Z., & Pollard, C. D. (2015). Single leg squat test and its relationship to dynamic knee valgus and injury risk
screening. PM&R, 7(3), 229-235.

Schoenfeld, B. J. (2010). Squatting kinematics and kinetics and their application to exercise performance. The Journal of Strength & Conditioning
Research, 24(12), 3497-3506.

Willson, J. D., Dougherty, C. P., Ireland, M. L., & Davis, I. M. (2005). Core stability and its relationship to lower extremity function and injury.
Journal of the American Academy of Orthopaedic Surgeons, 13(5), 316-325.