Home Posts tagged "Balance Training"

Strength and Conditioning Stuff You Should Read: 7/21/20

Here's some recommended reading from around the 'Net:

What Really Constitutes Functional Balance Training? -This is an old blog of mine that I'm "re-upping" here because of a conversation about specificity of balance training that I had with an athlete the other day.

How to Have Impossible Conversations - I just finished this as an audiobook, and it was outstanding - especially in light of recent events in the world. There are definitely lessons for every strength and conditioning/fitness and sports medicine professional.

Sport specialization is associated with upper-extremity overuse injury in high school baseball players - Here's (yet another) study demonstrating a drastic increase in injury rates in those who specialize in one sport. In this particular study, highly specialized high school baseball players from California, Alabama, and Michigan were 3.77 times more likely to have had an upper extremity injury in the previous year than their non-specialized counterparts.

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Strength and Conditioning Stuff You Should Read: 5/13/19

I hope you had a great weekend. After being a bit all over the place on when I published these features, we're back on a Monday schedule with these recommended readings.

Table for One: How Eating Alone is Radically Changing Our Diets - I came across this article on The Guardian the other day and found it really interesting socially and nutritionally.

Speed Training for Hockey - I don't have a big hockey following on this blog, but Kevin Neeld (Head Performance Coach for the Boston Bruins) is a good friend, former intern, and super bright mind in the hockey training field. He just released this resource, and it's available at an excellent discount. If you train hockey players (or are one), it's a no brainer to pick it up. I actually went through it and found some excellent ideas we can use with our baseball athletes as well.

5 Important Lessons on Balance Training - I wrote this article about a year ago, and a recent social media discussion brought it back to the forefront.

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Here’s a preliminary rendering of the new 10,000-square-foot @cresseysportsperformance FL facility in #palmbeachgardens. It’ll open up this winter. Some notes: 1️⃣ the grassy area in front of the building will actually be a turfed infield and double as a Miracle League field 2️⃣ the West (left, in this photo) end of the roof will extend out to cover hitting cages and pitching mounds 3️⃣ we aren’t renaming CSP as “The Sports Center;” we’re just working through signage logistics 4️⃣ the building will back up to the right field line of a showcase stadium field 5️⃣ this is the view from @lomogram’s parking spot 🤣 We’re excited for what will be a great one-stop shop for athletes and general fitness clients alike. In particular, Palm Beach Gardens is quickly evolving as a training and competitive destination for baseball players from around the country. We’re thrilled to be a part of that evolution. #cspfamily

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5 Important Lessons on Balance Training

You'll hear the terms "stability" and "balance" thrown around a lot in the personal training, strength and conditioning, and rehabilitation communities, but they're often covered in very vague terms - and with hastily thrown together exercise progressions. Let's cover some things you need to appreciate to be more informed in this regard.

1. Balance and stability are not the same thing.

In Basic Biomechanics, Susan Hall (2003) defined stability as "resistance to both angular and linear acceleration, or resistance to disruption of equilibrium.” Conversely, she defined balance as "the ability to control equilibrium” or “the process of maintaining the center of gravity within the body’s base of support within a given sensory environment.”

In other words, stability is  a state, and balance is a proficiency. Your level of stability is constantly changing based on environmental factors, external influences working on you, and your positioning. Balance is something you have (or lack) to varying degrees; neural factors such as muscular strength, kinesthetic awareness, coordination, and proprioception all contribute to one’s balancing proficiency.

In training, we often reduce stability (e.g., go to unilateral instead of bilateral stance) in order to train to improve our balancing proficiency.

2. Static and dynamic balance are only loosely correlated.

All the way back in 1967, Drowatzky and Zuccato observed little carryover from static to dynamic balance skills, and it was proven again decades later by Tsigilis. With that in mind, it makes sense to train a "continuum" of balance challenges ranging from static to dynamic:

3. Balance is an easy and "free" adaptation to acquire.

If you watch all of the exercises I just outlined along that static-to-dynamic continuum, none of them are particularly taxing. In other words, they can be trained every day without having to remove a lot of other stuff from your programs out of concern for exceeding recovery capacity. The best way to improve balance is to train it frequently and with small exposures, even if it's as simple as telling athletes to brush their teeth on one foot. Nobody will overtrain on balance work.

4. Balance is skill specific.

Having great balance on hockey skates doesn't mean that you'll have elite balance on a basketball or tennis court. This is why it's so important to challenge balance in a variety of ways (by manipulating stability scenarios) in training; it increases the likelihood of "overlap" to the chaos that athletic participation throws at us.

5. Unstable surface training is simply one means of modifying stability in a given situation - but that doesn't mean that it's an appropriate or safe method of training balance.

I spent two years of my life studying unstable surface training (UST) for my master's thesis, which was published in the Journal of Strength and Conditioning Research in 2007. Suffice it to say that there are a few scenarios in which UST can be very useful, most notably the rehabilitation of functional ankle instability. Usually, however, over avenues of stability manipulation are much better ways to enhance balance.

With that in mind, if you'd like to learn more about not only unstable surface training, but all the different ways you can alter stability to enhance balance in your training programs, I'd strongly encourage you check out my e-book, The Truth About Unstable Surface Training.

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Strength and Conditioning Stuff You Should Read: 11/7/17

I hope you all had a great weekend. I just got back in the wee hours of Monday morning after teaching a shoulder course in Atlanta, so the new content at EricCressey.com will come in a day or two.

In the meantime, here's some recommended reading for the week:

The Power of Moments - If you've followed me for any length of time, you'll know that I'm a fan of Chip and Dan Heath's writing. This book is no exception, and for any of the fitness entrepreneurs (or any entrepreneurs) out there, I'd call it a must-read.

What Really Constitutes Functional Balance Training? - I had a discussion with another coach the other day about how to approach balance training in athletes, and it reminded me of this old blog of mine. 

Skill Acquisition Considerations for Athletes - These are lecture notes from a recent presentation Nick Winkelman delivered, and they're absolutely outstanding. I'd call this a must-read for any coach.

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Strength and Conditioning Stuff You Should Read: 7/18/17

I've been crushing audiobooks, print books, and DVDs of late, so it's generated some good material for these weekly installments.

Certified Program Design Specialist Course - Robert Dos Remedios just released this course, and I'm working my way through it right now. Program Design is this huge "hole" in industry education; it's so incredibly complex to teach that I'm impressed that Dos even tried to tackle the project! I've enjoyed what I've seen thus far, and this could be a great resource for up-and-coming coaches. It's $100 off this week as an introductory discount.

Smart Baseball - I really enjoyed Keith Law's new book, as it delved heavily into the world of advanced statistics in baseball. If you're a casual observer to the sabermetric world, this would be a good read for getting up to speed - and it'll help you watch baseball through a different lens.

The Quadruped Rock-Back Test: RIP - Doug Kechijian just published this article that asserts that this classic test probably doesn't hold as much merit for predicting squatting success as one might think.

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Big Toe, Big Problems

Today's guest post comes from Cressey Sports Performance colleague, Dr. James Spencer. Enjoy! -EC

Epidemiological research suggests that the incidence of foot problems, specifically issues with the first metatarsalphalangeal joint (MTP) is common (1). These common big toe and foot problems are exposed in the systematic approach of the Selective Functional Movement Assessment (SFMA) and Functional Movement Screen (FMS). The big toe condition I would like to highlight is Functional Hallux Limitus (FHL). FHL is a separate distinct diagnosis from Structural Hallux Limitus (SHL). FHL is characterized by a lack of dorsiflexion of the first MTP joint during the gait cycle only (2).

mtpjoint

The one problem that I typically see with this condition is how infrequently diagnosed it is. The reason for this may be that patients may not have experienced pain in their toe or a drastic compensation pattern. Additional research also reported that the presence in foot symptoms does not necessarily correlate with the presence of dysfunction and that patients may be experiencing dysfunction without having any accompanying symptoms (1).

The big toe is a very underestimated player in the Joint by Joint Theory. Popularized by Gray Cook and Mike Boyle, the Joint by Joint approach is alternating series of stable segments on mobile joints, where (generally):

1st MTP: Needs Mobility
Mid-Foot: Needs Stability
Ankle: Needs Mobility
Knee: Needs Stability
Hip: Needs Mobility
Lumbar Spine: Needs Stability
Thoracic Spine: Needs Mobility
Cervical Spine (lower): Needs Stability
Cervical Spine (upper): Needs Mobility
Shoulder: Needs Mobility
Elbow: Needs Stability
Wrist: Needs Mobility

You could see how an alteration in this Joint by Joint approach could affect the mechanics and joints up and down the kinetic chain. In this article I would like to explore FHL and its interplay with Regional Interdependence, which refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint (3). Therefore, you could see how a lack of big toe mobility can lead to a wide spread of conditions locally, at the joint, and systemically, up the kinetic chain and beyond. For example, some associated signs and conditions may include overpronation, ankle mobility restrictions, toe out posture, posterior tibialis tendinosis, achilles tendinosis, plantar fasciitis and patellar tendinosis, just to name a few. Regional interdependence displays the amazing anatomical and biomechanical interconnection throughout the human body.

Functional Anatomy

The first metatarsal is the shortest and thickest of the metatarsals. Two sesamoid bones, encased in the tendons of the intrinsic muscles, lie beneath the head of the first metatarsal. Suggested sesamoid function for the first metatarsal allows the big toe to plantar flex during extension of the hallux, enhance the load-bearing capacity of the first metatarsal, and to improve the mechanical leverage for the attached intrinsic muscles (4). Depending on the literature you read, the first ray is designed for 50-70 degrees of big toe extension during static evaluation. However, I would argue that 45 degrees of big toe extension is actually adequate during the gait cycle. This is supported with the work of Nawoczenski in the Journal of Bone and Joint Surgery. I could not find any published research on if these values were different during the running cycle. If you look at Thomas Myers’ work with the Superficial Back Line (SBL), you can see how the lack of big toe extension could wreak havoc on the entire kinetic chain via regional interdependence.

anatomy-trains

Originating from the plantar aspect of the calcaneus, the plantar fascia is more than just a passive band of connective tissue. As the plantar fascia travels distally towards the toes, it separates into five slips of fascia. Each plantar fascia slip inserts plantarly onto each of the five digits. As the foot transitions from midstance into push-off, the toes begin to dorsiflex and the plantar fascia is activated. This activation of the plantar fascia upon hallux dorsiflexion is referred to as the “windlass mechanism” and is the second step in preparing the foot for propulsion.

Gray443

Since power during propulsion is dependent upon the foot’s ability to become a rigid lever, ensuring proper hallux dorsiflexion during the gait is key to achieving full foot supination (5). Considering that during gait, the entire body is advancing past this single joint, the ability to dorsiflex, and subsequently raise the heel during single support phase while simultaneously supporting against the developing forces for forward motion is essential for normal, efficient gait. If this mechanism fails, sagittal plane compensation will be forced to occur (6). When the first MTP joint motion is disrupted enough to prevent stabilization of the foot structure during maximal hallux dorsiflexion, through the effect of the windlass mechanism, then normal foot stabilization during propulsion is disrupted, and becomes clinically significant (7).

Aside from the specific biomechanics that are addressed in the lower quarter, looking at mobility loss more globally will always relate to an anterior weight shift. Repetitive function with an anterior weight shift yields facilitation and inhibition in a very predictable pattern.

Common Compensations with FHL

Compensations will occur due to injuries, faulty mechanics and previous experiences. We have to take a step back and realize our CNS (Central Nervous System) is a high-speed train moving forward with “Life;” therefore, compensations will inevitably occur throughout our lives. We could blame previous injuries, posture, ergonomics, it really doesn’t matter what we point the finger at, but our CNS will continue to move forward whether the movement is mechanically advantageous to us or not. The key is not allowing compensatory patterns to become engraved as movement patterns. The CNS loves stimulation and constant feedback for neuroplasticity.

This video displays amazing neurological changes and shows how habits, movement patterns and previous experiences influence our neurological systems. Plus, you have to appreciate the MacGyver Mullet comment! I also want this to be an eye opener for people to see how long it can take to learn new motor skills and how easily it is to revert right back in to an old pattern.

Some of the most common compensations that I see consist of limited proprioception in the midfoot, limited ankle mobility, and limited hip extension. Limited proprioception in the midfoot can lead to plantar fascitis or medial arch stress. Limited ankle mobility - typically dorsiflexion - is another common imbalance that must be assessed in a client seeking power at propulsion. Normal gait requires at least 10 degrees of ankle dorsiflexion with maximum ankle dorsiflexion occurring during late midstance. Limited ankle mobility can lead to a myriad of compensations including midfoot pronation, knee hyperextension and an early heel rise during gait (5). Limited hip extension can lead to abduction compensation and produce the classic overpronated foot type and abducted stance position. The stride length shortens and reduces hip extension and glute activation. As Charlie Weingroff has noted, this is caused when the correct pathway of motion is blocked by the lack of 1st ray dorsiflexion, the person will produce an abducted foot in order to roll off the inside of the toe in order to allow for hip extension (8). I find that this compensation is most often related to the development of Hallux Valgus and bunion formation.

Corrective Strategies

Here's one of my favorite simple drills to use (in combination with manual therapy) with folks with FHL:

I also like to progress individuals to 2x4 walks to integrate this pattern in balance training:

Final Thoughts

Your big toe is essential for proper balance, running, walking and many other athletic activities or exercises. As the foundation to human movement, optimal power during propulsion is dependent upon proper foot posture and muscle activation patterns. With every step, the human foot must convert from a mobile adaptor at midstance to a rigid lever for propulsion. Integrating foot-specific exercises sets the foundation for sufficient foot strength and forefoot re-supination. The quicker the foot can become a rigid lever, the greater the power that is unleashed during propulsion (5). I believe that there is inadequate diagnostic criteria for clinicians to properly diagnose FHL. Since FHL is diagnosed during closed kinetic chain, we should look in to a more definitive way to diagnose this functional condition. Moreover, a dynamic gait analysis that shows timing and pressure differences in the foot may be a good source of objective measurement for future diagnostic criteria.

My goal of this article is to raise awareness of how important the big toe mobility and stability is for every day life and function. Please don’t take the movement algorithm of walking for granted because it is one of the most complex movements the human body performs. Let this final picture be a reminder to never chase pain when evaluating or treating someone and keep the thought of regional interdependence in mind.

Note: references for this article will be posted as the first comment below.

About the Author

spencerBased in South Florida, Dr. James Spencer is a Sports Performance Chiropractor, Certified Athletic Trainer, and Fellow of the International Academy of Medical Acupuncture. He has formal training in Active Release Techniques, Graston Technique, Kinetacore Functional Dry Needling, SpiderTech Kinesiology Tape, RockTape Fascial Movement Taping, Postural Restoration Institute, Y-Balance Test, FMS, SFMA, Mike Boyle’s Certified Functional Strength Coach and the Onnit Academy of Unconventional Training. You can find Dr. Spencer on Facebook, Instagram and at www.DrJamesSpencer.com


 

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