Preventing ACL Injuries Part 2: Multi-Planar Hip Mobility

In Part 1, I addressed how a loss of ankle mobility can be a contributing factor to knee pain or a factor in ACL injuries.  In Part 2, hip mobility will take the front seat as this is the second (not secondary in importance) major joint area that can become restricted and can cause knee issues which can turn into an ACL problem.

Our first priority is restoring mobility.  I am a big believer in Charlie Weingroff’s Core Pendulum Theory which states that when the mobility of our joints is compromised, the ability to authentically stabilize becomes less than optimal.

Fulll mobility is needed so that we have a neutral, then we lock it up with stability and movement

At the hip, we have the ability to mobilize is a variety of planes.  With soccer players (and hockey), we primarily see a loss of hip internal rotation (mostly males).  Without restoring hip internal rotation, muscles that prevent hip internal rotation (gluteals) will be clueless to work to prevent hip internal rotation (valgus collapse).  Here are some great mobilizations…

1-Leg SLDL Rotation or “Supported Hip Airplane”: Mobilize in the transverse plane (internal/external rotation mob.). Make sure to drive the hip all the way down to mobilize into hip IR. It is also a great way to teach dissociation between the pelvis and leg.  As you move through the motion be sure to prevent the knee from moving.

Diagonal Hip Rock w/ Step: The first movement is a combined flexion, adduction, and internal rotation followed by an extension, abduction, external rotation (hip driven forward).

Lying Knee to Knee AIS

 

3- Way Hamstring:

These are a few ways we like to improve the hip mobility deficits (hip IR).  The other way we can help hip IR is by working in the sagittal plane to restore hip flexion.

Split Squat Holds for time (20-60s)ham or with 3-4s Negatives

 

Next series of posts will focus on how to incorporate more stability based movements to reinforce the newly-gained mobility we have gained in the hip and ankle.

Cheers,

Matt

 

Under Prepared, Over Injured

Last Saturday it was gorgeous out and considering that I used to love running, wait take that back, I mean sprinting, I thought  it would be a great time to go for a run.  My routine (a  mistake)….

• Put running shoes on
• Wear my old school belly cut Charles Woodson #2 jersey on with some classy running shorts
• Step outside, shake my legs and off I went :  60s run followed by 60s walk until I got back to my house (approx 2- 2 1/2 miles)

Now,  not that you would go to hell for this (at least my calves did for 3 days after), but doesn’t the quick “get it and go” mentality put us in a pretty bad disposition to get hurt?  I know so, and so do those who begin some fitness endeavor with no movement quality, without a quality warm-up, and at an intensity that is usually too high to begin with.  I also know that this is typically the situation at the middle or high school levels in warm-ups.  My experiences were these…

• Soccer: Run around the field once or twice and then do some leg swings in various planes along with some skipping groin thingies that I still see to this day
• Football: Jog 75 yards at a pace closely resembling a walking herd of cows followed by some static stretching
• Track: Run 2 laps around the track followed by some A & B skips, butt kickers, striders, backward runs

As you can see, there is not much except some jogging, and faster based movement skills like skips, form runs, etc…all which are good.  The preparation could have been much better and should be (currently) knowing what we know now.  Hopefully this is not the same but I do fear it is.  If it is,  make sure you get that someone’s attention by giving them a….”Hey Yo” 10x’s or until they almost want to punch you in the face. 

Quick side note: I used to love Scott Hall, aka Razor Ramon when I was a kid and after re-watching the E:60 show on his life now, I felt pretty darn sad.  I guess in many wrestlers cases, they are overworked, overinjured, and under recovered.  The spotlight or their demons can sometimes get the best of them.

Under prepared, Over Injured:  The title is exactly what it means, and the examples I provided are only examples of poor preparation but preparation goes beyond the warm-up.  Mainly, the off-season preparation needed in sports or the continual striving of a goal for a personal training client.  Take for example someone who loves to run.

It could be knee, ankle, low back, shoulder..you name it

They start to experience knee pain.  In time, the pain will get worse, prevent them from enjoying running, or soon stop them completely.  Why?  Running (along with almost ALL activitiy) requires degrees of strength, endurance, coordination, flexibility, balance, mobility, and stability.  What is the running singularly working on?  Their endurance.  To stay healthy or to improve, they need to be prepared with adequate levels of strength, mobility, stability, coordination, etc…The preparation or actual running itself is improving one quality causing a dramatic shift in one direction towards a quality that requires a balance of all the ones listed above.  The same goes for athletes or the general person wanting to be healthy.  If you have nagging injuries, or are not seeing results, if you start preparing correctly and doing the things throughout the day to be successful or less likely to be injured, the chances are you will see results.

Cheers,

Matt

Various Ankle Mobility Exercises

     When taking a bottoms up approach to assessing or observing the way people move, the first thing that comes to mind is the ankle.  One of the major mobility restrictions is ankle mobility, or lack of ankle dorsiflexion (with the heel in contact with the ground).  In order to squat, run, lunge, & jump effectively, an athlete needs a good amount of ankle dorsiflexion and without it, compensation will occur somewhere up the kinetic chain.  There are many compensations to look for such as an out-toeing of the feet (which can also be caused from lack of hip internal rotation).   Concurrent with the joint-by-joint philosophy, restricted ankle mobility can result in knee pain, hip problems, low back pain, even opposite shoulder dysfunction.  Think of the squatting pattern, if you do not have adequate mobility at the ankle (and subsequent lack of hip flexion & internal rotation), you will hit end range at the hips early and round at the lumbar spine.  Most people know that squatting with a rounded back is one hell of a way to destroy something.  Check out the video below.  Notice the lack of dorsiflexion which causes early pronation at the ankle and hip internal rotation.

      Lacking adequate mobility in the areas that typically need it more than others (t-spine, hips, ankles) can inhibit the proprioception and stability of certain muscles.  Mobility needs to be the first priority followed by stability.  Try to think of it like this:  if you were to lose mobility somewhere then stabilizing muscles will not know how to work  because the body has never been put in that position to try to stabilize. Example..if you cannot internally rotate your hips (think lack of ankle dorsiflexion as well) then muscles which prevent hip IR (think glutes) do not know what it feelsl like to work because it has never been put into IR.  If I lost you, in due time I will have to come back to this topic.

These are various ankle mobility drills that we use with our athletes and ones that I really like.  Be sure that will all of them to keep the weight on the heel while driving the knee forward and to keep it aligned over the 2nd or 3rd toe. 

Wall-Ankle Drill

• Start with your toes touching the wall and work your foot back as long as your heel stays down and your knee can touch the wall.  In the video, when I slide my foot back to try to get more ROM my heel comes off the ground slightly.  In this case, you get closer to the wall and stay there.

Lateral Rock into Ankle Drill

• Using different planes of motion to achieve greater mobility is something I learned from Gary Gray.  In this exercise you can use the frontal plane to get more out of sagittal plane mobility.  Another example is using thoracic rotation drills to get more thoracic extension ROM.

 

1/2 Kneeling Ankle w/ Band Traction

• The use of  the band can help with anyone who has a “pinching” feeling with other ankle mobility drills.  The pinching they are feeling may be some sort of impingment at that area.
• This is also a great way to work on hip extension on the back leg

     When assessing the ankle it also helps to ask what the athlete feels when you press their toes toward their shins (legs straight).  If they say they feel it in the back of the leg (calf) then plenty of soft tissue work with the lacrosse ball on the calves and plantar fascia can help.  If they feel “stuck,” then it is more of the joint being restricted and not necessarily muscular in nature.  Either way using a PVC, lacrosse ball, or barbell should be in order considering most people wear pretty bad sneakers with giant heel lifts.  These are few out of many different ankle mobility drills that can be used with people and are easily incorporated into warm-ups or as filler exercises.  Try them out and let me know

Cheers,

Matt