an interdisciplinary approach to the hip and groin
Nick Grantham Performance Enhancement Specialist MSc, CSCS, ASCC Monday, 23 May 16
operate at
80% 60%
of players of their capacity
Monday, 23 May 16
operate at
80% 60%
of players of their capacity
Monday, 23 May 16
operate at
80% 60%
of players of their capacity
Monday, 23 May 16
operate at
80% 60%
of players of their capacity
Monday, 23 May 16
operate at
80% 60%
CONTRAST
what have they got in the bank?
what are they prepared for?
of players of their capacity
Monday, 23 May 16
aggregation of marginal gains Alasdair Lane - Lead Out Coaching Why the Marginal Gains Concept Fails in Football September 2015 Monday, 23 May 16
aggregation figure out why the basics that give the of marginal biggest returns aren’t being done gains and then find a solution Alasdair Lane - Lead Out Coaching Why the Marginal Gains Concept Fails in Football September 2015
Monday, 23 May 16
Monday, 23 May 16
Gabbett TJ. Br J sports Med 2016
Monday, 23 May 16
greater resilience
Gabbett TJ. Br J sports Med 2016
Monday, 23 May 16
greater resilience
well-developed physical qualities are associated with a reduced risk of injury
under-training may increase injury risk
Gabbett TJ. Br J sports Med 2016
Monday, 23 May 16
the problem is not with training per se, but more likely the inappropriate training that is being
prescribed. greater resilience
well-developed physical qualities are associated with a reduced risk of injury
under-training may increase injury risk
Gabbett TJ. Br J sports Med 2016
Unimodal rehabilitation interventions and generic rehabilitation prescription based solely on evidencebased medicine are unlikely to be optimal in the rehabilitation of injuries particularly in athletes Scott A, et al, Br J sports Med 2013
Monday, 23 May 16
Monday, 23 May 16
focusing on injury mechanism may be more productive rather than attempting to isolate individual pathological structures.
Athletic groin pain ( part 1): a prospective anatomical diagnosis of 382 patients clinical findings, MRI findings and patient-reported outcome measures at baseline Falvey ÉC, King E, Kinsella S, et al. Br J Sports Med
Monday, 23 May 16
TOO MUCH
TOO FAR
Inability to tolerate the force generating or force dissipating demands of a muscle action
Inability to tolerate the required working range of motion of a muscle action
focusing on injury mechanism may be more productive rather than attempting to isolate individual pathological structures.
Athletic groin pain ( part 1): a prospective anatomical diagnosis of 382 patients clinical findings, MRI findings and patient-reported outcome measures at baseline Falvey ÉC, King E, Kinsella S, et al. Br J Sports Med
Monday, 23 May 16
optimal function
efficient load transfer through range of motion
Monday, 23 May 16
Developing an appropriate strength training programme for your athlete is based on three elements
Monday, 23 May 16
Developing an appropriate strength training programme for your athlete is based on three elements
Understanding the strength requirements
Monday, 23 May 16
Developing an appropriate strength training programme for your athlete is based on three elements
Understanding the strength requirements
Knowledge of the most appropriate training techniques to develop those strength requirements
Monday, 23 May 16
Developing an appropriate strength training programme for your athlete is based on three elements
Understanding the strength requirements
Knowledge of the most appropriate training techniques to develop those strength requirements
Understanding how these training strategies should be incorporated into a long-term plan [phase potentiation]
Monday, 23 May 16
Histories of intense sports activities that require abrupt acceleration, kicking, rapid alternation of single-leg load bearing, abrupt changes in direction and circular movement of the trunk are generally present, and groin pain is a common reason why top-level athletes may be kept away from their sport.
Rodrigo Castelo Branco, CĂŠsar Rubens da Costa Fontenelle, Leandro Marques Miranda, Yonder Archanjo Ching San Junior, Evandro Miguelote Vianna, Rev Bras Ortop. 2010;45(6):596-600
tend to neglect the muscles responsible for the other important hip movements Agonist Muscles
Hip Muscle Anatomy
is not the magic number neither is 3
1 Anatomical Movements
Gluteus maximus, biceps femoris (long head), semitendinosus, semimembranosus
Tensor fasciae latae, gluteus medius, gluteus minimus, sartorius
Hip Extension
Hip Abduction
Adductor magnus, adductor longus, adductor brevis, gracilis, pectineus
Iliopsoas, rectus femoris, sartorius, pectineus
Hip Adduction
Gluteus medius (anterior fibers), gluteus minimus, semitendinosus, semimembranosus, gracilis
Hip Flexion
Hip Internal Rotation Hip External Rotation
Iliopsoas, gluteus maximus, gluteus medius (posterior fibers), biceps femoris (long head), sartorius, gemellus superior, gemellus inferior, obturator externus, obturator internus, quadratus femoris, piriformis
Importance of Comprehensive Hip Strengthening Holcomb, M.G., Miller W.R. and Rubley M.D 2012, Strength and Conditioning Journal 34 (1)16-19 Monday, 23 May 16
Monday, 23 May 16
Power of Six [1] [2] [3] [4] [5] [6]
Monday, 23 May 16
Power of Six
obsessed with adductors
obsessed with extensors
[1]Flexion [2]Extension [3]Adduction [4]Abduction [5]Internal Rotation [6]External Rotation
multi-planar conditioning
Monday, 23 May 16
Beyond 3 sets of 10
training within a specific repetition range will produce specific adaptations
V B T ≤0.75m/s
strength speed
strength
moderate loads moderate velocity
heavy load slow velocity
Beyond 3 sets of 10
13 14 15+
training within a specific repetition range will produce specific adaptations
9 10 11 12
MUSCULAR ENDURANCE AND LIMITED HYPERTROPHY
METABOLIC [CELLULAR] SETS [LOW 2-4]
OPTIMAL HYPERTROPHY
very light loads high velocity
light loads high velocity
0.75-1.0m/s
ABSOLUTE STRENGTH AND HYPERTROPHY
678
speed
1.0m/s-1.3m/s speed strength ≥1.3m/s
adapted from Bryan Mann
12345 RELATIVE STRENGTH
NEURAL [NEUROMUSCULAR] SETS [HIGH 5-12] Monday, 23 May 16
Adapted from Duncan French, 2015
Conditioning Strategy
Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16
Adapted from Duncan French, 2015
BW activation Dynamic resisted control Dynamic high load resisted
Conditioning Strategy
Corrective
Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16
Adapted from Duncan French, 2015
BW activation Dynamic resisted control Dynamic high load resisted
Static flexion and extension Dynamic flexion and extension Dynamic multi-planar
Conditioning Strategy
Flexibility and Mobility Corrective
Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16
Adapted from Duncan French, 2015
BW activation Dynamic resisted control Dynamic high load resisted
Static flexion and extension Dynamic flexion and extension Dynamic multi-planar
Short lever - low load - low velocity Long lever - high velocity low load Long lever high velocity high load
Conditioning Strategy
Unilateral Stability Flexibility and Mobility Corrective
Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16
Closed-chain flexion Open-chain flexion Open chain flexion-adduction
Conditioning Strategy
Unilateral Strength
Short lever - low load - low velocity Long lever - high velocity low load Long lever high velocity high load
Adapted from Duncan French, 2015
BW activation Dynamic resisted control Dynamic high load resisted
Static flexion and extension Dynamic flexion and extension Dynamic multi-planar
Unilateral Stability Flexibility and Mobility Corrective
Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16
Conditioning
Closed-chain flexion Open-chain flexion Open chain flexion-adduction
Lateral conditioning Resisted lateral conditioning COD / reactive agility
Conditioning Strategy
Unilateral Strength
Short lever - low load - low velocity Long lever - high velocity low load Long lever high velocity high load
Adapted from Duncan French, 2015
BW activation Dynamic resisted control Dynamic high load resisted
Static flexion and extension Dynamic flexion and extension Dynamic multi-planar
Unilateral Stability Flexibility and Mobility Corrective
Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16
Conditioning Strategy
Lateral conditioning Resisted lateral conditioning COD / reactive agility
Heavy eccentric control High impulse eccentrics Coupling (concentric/eccentric)
Conditioning
Closed-chain flexion Open-chain flexion Open chain flexion-adduction
High Impulse Loading
Unilateral Strength
Short lever - low load - low velocity Long lever - high velocity low load Long lever high velocity high load
Adapted from Duncan French, 2015
BW activation Dynamic resisted control Dynamic high load resisted
Static flexion and extension Dynamic flexion and extension Dynamic multi-planar
Unilateral Stability Flexibility and Mobility Corrective
Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16
Corrective Build on a foundation of pelvic alignment and muscle balance through loading
Flexibility and Mobility
Avoid simply performing traditional frontal plane movements
Unilateral Stability
you can’t fire a cannon out of a canoe - stability is control in the presence of change
Monday, 23 May 16
MOVEMENT QUALITY TRAINING - 1 Order Exercise Sets/Reps 1 Psoas Raise 5s-5s-5s-5s-5s-5s 2 Mini-Band Diagonals 10-10-10 ea 3 Groin Squeeze 10-10-10 ea 4 Offset 10-10ea Squat 5 Wide 10-10 6 Rot Squat 10-10 - All squat exercises are performed without external loading (bodyweight only) - Technique must be ‘flawless’ at all times
A-Wall Drills
MOVEMENT QUALITY TRAINING - 3 Exercise Sets/Reps Iso Psoas Raise 2s-2s-2s-2s-2s Mini-Band Side Steps - Athletic10-10-10 Athletic ea Walking 10-10-10-10-10 ea A Drills Drives 10-10-10-10-10 ea Iso Hold 15s-15s-15s-15s ea Switch + Hold5s-5s-5s-5s-5s-5s
MOVEMENT QUALITY TRAINING - 2 Order Exercise Sets/Reps 1 Seated Psoas Raise 5s-5s-5s-5s-5s-5s 2 Mini-Band Side Steps 10-10-10 ea 3 Keiser Adductor 20-20ea 4 Lateral 10-10 ea Lunge 5 Backward 10-10 ea 6 Drop 10-10 ea - All lunge exercises are performed without external loading (bodyweight only) - Technique must be ‘flawless’ at all times
Order 1 2 3 4 5 6
- Technique must be ‘flawless’ at all times
Unilateral Strength too much reliance on closed chain conditioning strategies
Conditioning
STRENGTH AND POWER - 1
Order Exercise Coaching Cue 1 Back Squat Weight through whole of foot 2 Gymaware - CMJ 3 Stiff Leg Deadlift Maintain good posture 4 Hip Thrust Squeeze glutes at top 5 SB Adductor Slide board - control 6 Sway Maintain athletic position and posture
STRENGTH AND POWER - 2
Sets/Reps Tempo Recovery 8-8-5-5 10X 30 5-5-5-5 X 120 8-8-5-5 10X 120 10-10-10 101 60 30s-30s-30s 1 0 1 60 10-10-10ea 111 60
Exercise
2 x 6 ea
3 x 10s
3 x 10s ea
2 x 10 ea
2 x 10 ea
2 x 10 ea
Sessions 1 - 4
2 x 6 ea
2 x 6 ea
3 x 15s
3 x 15s ea
3 x 10 ea
3 x 10 ea
3 x 10 ea
Sessions 5 - 8
2x6
1 x 6 ea
2 x 6 ea
3 x 20s
3 x 20s ea
3 x 10 ea
3 x 10 ea
3 x 10 ea
Sessions 9 - 12
Tempo Recovery 10X 60 X2 60 XX1 60 121 60 111 60 111 60
High Knee
-
1x6
3 x 15s
Sets/Reps 8-8-5-5ea 5-5-5-5ea 5-5-5-5ea 6-6-6-6ea 10-10-10ea 10-10-10ea
Heel Lift
-
-
RUNNING MECHANICS
Leg Drives
Switch - triple
-
Acceleration Switch - single Wall Drill Switch - double
March
Switch - continuos
Iso Holds
Order Exercise Coaching Cue 1 RFE Split Squat Maintain knee alignment 2 Split Squat Drop Alternate right and left 3 SL SLDL + LungeDynamic - fast switch 4 SL Bridge Foot on box, knee bent - hold for 2s 5 Sway Maintain athletic position and posture 6 Step + Sway Stay low throughout
Not as simple as strengthening adductors and lengthening abductors – think multi-planar
High Impulse Loading
Progressive overload to high impulse stabilisation and strength
Monday, 23 May 16
Monday, 23 May 16
Monday, 23 May 16
the athlete will regret not training the movements, speeds and loads that resulted in the injury
Monday, 23 May 16
players simply need to adopt a chronic training strategy
Monday, 23 May 16
the need for instant results disrupts continuity
Mark Gillett Richie Rawlins Andrew Leaver Fraser McKinney Matt Green Paul Caldbeck Simon Griffiths George Kiss Fergus Ross *Steve Wright *Chris Barnes *Mark Jarvis *Rick Carter *Paul Brice Monday, 23 May 16
Monday, 23 May 16
I hope today has been of real value Thank you [E] nick@nickgrantham.com [T] @coachnickg