ACL and Agility - You knew I had to bring it up

This particular post addresses anterior cruciate ligament replacement rehab; however, the protocols can be adjusted to appropriately address other orthopedic and physical therapy scenarios.

I had my right ACL replaced just over three years ago. The rehab exercises that I was prescribed were what I would consider basic; bike, step ups, wall squats etc. Giving some props to the physical therapists, we did move into some agility type drills using a speed ladder.

Regaining neuromuscular control is critical to restoring stability and functional movement patterns following ACL reconstruction. According to Brown and Ferrigno (2005), neuromuscular control is one of the outcomes from agility training. While some authors and therapists feel that neuromuscular training (NT) is key, others feel that strength training (ST) is of more importance. A 2007 study was competed to compare the outcome of NT versus ST on knee function (Risberg at al.). Seventy four subjects ranging in age from 15-41 were included in the study; 39 participated in NT while 35 participated in ST. Outcome measurements included The Cincinnati knee score (primary measurement for pain, swelling, giving way, general activity level, walking, stair climbing, running, jumping, and twisting activities), strength, balance, and proprioception as well as pain measurement and global knee function.

All patients spent the first week regaining range of motion and started the training protocols the second week. The NT group performed balance exercises, dynamic joint stability exercises, plyometric exercises, and agility drills. The ST group started with reducing the swelling and increasing range of motion of the knee followed by weight bearing exercises. Traditional strength exercises were then introduced along with single leg balance and after 13 weeks, running. Weights were adjusted accordingly to progress each patient.

At three months there was not a significant difference in the groups based on the measured outcomes. At the six month follow up the NT group scored significantly better on the Cincinnati Knee score than the ST group. The NT group also scored better with global knee function than the ST group. There were no significant differences in muscle strength, or dynamic balance. This study suggests that appropriate agility type exercises may provide better outcomes that traditional strength type exercises for ACL rehabilitation.

Brown, L., & Ferrigno, V. (2005) Training for speed, agility, and quickness. (pp.72-73) Champaign, IL: Human Kinetics

Risberg, M., Holm, I., Myklebust, G., Engebretsen, L. (2007) Neuromuscular training versus strength training during the first 6 months after anterior cruciate ligament reconstruction: a randomized clinical trail. Physical Therapy Volume 87 Number 6

Drink like a fish (water, that is)

I know this may sound simplistic, but it is too important to not address.

According to the National Academy of Sports Medicine (Clark, Corn, & Lucett, 2008):

· Water makes up 60% of the adult human body by weight

· Fluid loss of just 2% of body weight decreases performance and adversely impacts circulatory functions

· Thirst alone is a poor indicator of how much water you need (active individuals & athletes consistently tend to be dehydrated).

· As we age, we lose our ability to detect thirst, so it’s important to drink even if you’re not thirsty

Drinking water helps your body in the following ways:

· Alleviates fluid retention

· Improves liver functions; increasing the % of fat used for energy

· Significantly decreases appetite

· Improves metabolic functions

· Improves body-temperature regulation

· Maintains blood volume

· Distributes nutrients throughout the body

· Encourages natural thirst to return

· Improves endocrine gland function

Impact of Dehydration:

· Decreases performance, blood pressure, sweat rate, blood volume, cardiac output, blood flow to the skin,

· Increases heart rate, core temperature, water retention, sodium retention, perceived exertion, use of muscle glycogen

On average, people should drink 96 oz (3 quarts) of water a day.

People should drink an additional 8 ounces for every 25 pounds carried above healthy/ideal body weight, and if you're active you most likely need even more.

I know, 96 oz seems like a lot. But if you break it down, that’s the same as:

· Three 32 oz bottles or

· Four 24 oz bottles

· Twelve 8 oz cups a day

How do I meet this goal of drinking 96 oz a day?

Consider using one larger (24 or 32 oz) water bottle a day. Each time you finish and refill it, mark it or write it down.

Perhaps you are concerned you’ll have to use the bathroom a lot from drinking so much. This is just another benefit to drinking so much! In addition to ridding your body of toxins, each time you get up and move you’re giving your body a nice needed stretch break. Besides, after a few weeks, the need to relieve yourself will diminish. Now go drink like a fish!

Clark MA, Corn RJ, Lucett SC, . NASM Essentials of Personal Fitness Training. 3rd Ed. Lippincott Williams & Wilkins. 2008.

Quickness

This is part four of the Speed, Agility, and Quickness series. Part one was a brief intro with a list of some recommended exercises and also all of the references. Part two included rationale for exercises to enhance speed and part three discussed agility. Part four focuses on quickness. Keep in mind that I wrote these from the perspective of a martial artist. If you employ the rationale behind each attribute, speed, agility, or quickness, you should be able to develop your own drills for whatever activity you choose.

The ability to quickly act and react to your opponents movements will determine success. According to Foran (2005) “quickness involves reaction time and movement time in response to a specific stimulus or set of stimuli” (p.8). Mori, Ohtani, & Imanaka, (2002) report that simple reaction times, one stimulus and one possible response, between athletes and non-athletes (expert and novice) are virtually equal. It is only when movement is incorporated and there is more than one stimulus and/or more than one possible response that athletes perform superior to non-athletes. The time it takes to make a decision based upon the stimulus is shortened. This suggests that an improvement in response time can be achieved by an improvement in reaction time based on the anticipation or perception of what is happening and the selected response chosen. Training drills to improve quickness need to require a response to a stimulus in which the participant must act quickly in a manner that is skill specific.

Bruce Lee was once quoted as saying that to be flexible and ever changing, one must be a mirror; respond like an echo (Little & Lee-Caldwell 2000). He was referring to the ability to mirror and respond to his opponent’s movements. Although little, if any, research has been conducted with mirror drills and martial arts, Salonikidis & Zaferidis (2008) state that 15-20 minutes of lateral and linear drills two or three times per week help tennis players react and move faster. Coupled with improved response times based on an opponent’s movements, a directional mirror drill can improve processing speed and provide valuable anticipatory experience based on opposing movements (Brown & Ferrigno, 2006). The idea is for one person to mirror another who is performing multi-directional foot and limb movements. Person one initiates a step or a hand movement, person two reacts by mirroring person one.

Similar to reacting to an opponent’s body movement, the ability to respond properly to an oncoming strike is equally essential. Medicine ball training not only benefits coordination as the body acts as a whole to achieve certain throwing movements, it also increases reaction time by mimicking natural movements and speeds as the performer receives the oncoming ball (Faigenbaum & Mediate, 2006; Brown & Ferrigno, 2006). Throwing a medicine ball into a wall and receiving it back can help a martial artist with punching speed and power as the whole body moves to accomplish the technique. The medicine ball chest pass will also improve reaction time and movements as the performer responds to the ball quickly returning off of the wall.

One of the unique characteristics of Jeet Kune Do is that practitioners train in four ranges of combat; kicking which is furthest out, punching, trapping or clinch, and on the ground. However, if one would rather work from kicking or punching range but an opponent would rather work from the ground or clinch range, then pushing away from an opponent, or off of the ground, becomes significant. Plyometric push ups increase upper body power and strength allowing for more velocity when pushing as well as increasing quickness in the upper body musculature (Vossen, Kramer, Burke, & Vossen, 2000; Brown & Ferrigno, 2006). To perform a plyometric push up, start in the high plank position; complete the push up with enough force so that the hands leave the ground. Repeat the process with as little ground contact time as possible, or repeat the process based on a specific cue such as a whistle. Variations can include clapping while in the air, shifting weight from one side to another, moving hands into a different position upon each landing, or rolling a medicine ball from one hand to the other while in the air.

Directional mirror drill

· Incorporate into martial arts warm up or use as a training drill during class

· 3-5 minutes for warm up (rest every 30 seconds for one minute)

· 15-20 minutes as class drill (rest every few minutes as participants need)

· Will help with

o Reactive movements

o Faster thought processing and anticipatory time

Medicine ball wall toss

· Incorporate into strength training program

· 3 sets of 10-15 tosses

· Will help with

o Total body power

o Punching speed and power

o Reaction time

Plyometric push up

· Incorporate into strength training program

· 2-3 sets of 10

· Will help with

o Upper body strength

o Explosive power

o Quickness of upper body movements

Agility

Agility is defined as the ability to stop, start, and change the direction of the body or body parts rapidly in a controlled manner. Agility allows for performing techniques at high velocity with minimal loss of speed and balance. Training drills should address strength, power, acceleration, deceleration, coordination, and/or balance (Baechle & Earle, 2008; Lee & Ferrigno, 2005).

As opposed to other activities that involve running or other actions in a large field or court of play, most martial arts require that the practitioner have base and balance to execute techniques. Contemporary Jeet Kune Do expert, Paul Vunak (2001), states that the most important attribute of any physical altercation is the ability to get your opponent off balance; however, being able to launch a coordinated attack against an unwilling opponent while remaining balanced requires the practice of training drills that transfer specifically to the intended task. If the weight of the fighter, or the line of action, moves beyond the boundaries set by the base of support, the center of gravity (COG) becomes disturbed and the fighter will be unable to maintain balance. Brown & Ferrigno (2006) suggest that agility is closely aligned with balance as it involves maintaining postural equilibrium during movement of the body as a whole or individual body parts. Simultaneously training balance and movement makes use of a number of neurological pathways as it requires feedback for motion as well as a musculoskeletal response (Clark & Russell, 2007; Brown & Ferrigno, 2006). Training that involves disruptions to the equilibrium prepares the martial athlete for applied internal and external forces by increasing the neuromuscular capacity and decreasing action/reaction time (Yaggie & Campbell, 2006).

Many studies regard jumping rope as a plyometric drill used to develop quickness; which it is as jumping rope does utilize the SSC. However, if minimizing the loss of speed while shifting body weight is integral to agility training (Brown & Ferrigno, 2005), than jumping rope qualifies. Learning to perform footwork and apply kicking drills (fig. 6-8) while jumping rope prepares the practitioner to remain balanced while moving the whole body and/or individual limbs. Winkler (2007) states that proper rope jumping mimics the type of movements that are used in sports where one is moving forward and back while kicking, throwing, or striking. Practicing footwork, shadow boxing, and kicking while jumping rope will improve timing, agility, and rhythm, (Winkler, 2007) as well as help with single and double leg balance, and coordination (Gadeken, 1999).

In martial arts, although base and balance is required while executing a technique, often times one or two steps are taken prior to the execution of a technique. The hop and stick drill increases the ability to maintain balance in an active setting (Brown & Ferrigno, 2006). The idea is to move forward, laterally, medially, or backward, then, on a cue, stick and hold the landing. Originally designed for field sports, this drill can easily be adapted for martial arts by limiting the number of hops. Other adaptations can be made by using targets such as rings (fig. 10) or an agility ladder, landing on one leg, or by executing a technique after a successful landing.

Tumbling is more often associated with gymnastics than fighting. Nevertheless, rolling techniques can be used to cover distance, escape from a joint lock, or, when a disruption to the COG occurs and base and balance are compromised, a controlled roll is a means to recover from a fall. A proper roll develops total body agility and kinesthetic awareness as the kinetic energy is transferred into rotational energy (Terry, 2006; Brown & Ferrigno, 2006). Rolls can be performed forward and backwards as well as laterally. Start in a low squat with one foot slightly forward. As the fall begins, use the forward arm to create a bridge to the opposite foot. Roll along the line of the bridge and over the forward shoulder. To finish, use momentum to come back to the feet. Progressions can be performed by adding a step or two prior to the roll, being pushed into the roll, or holding on to an object such as a knife or stick through out the roll.

Jump rope

· Incorporate into conditioning warm up drills

· 3-5 minutes

· Start with 20 seconds fast with one minute of moderate pace

· Will help with

o Timing

o Coordination

o Dynamic balance

o Power

Hop and stick

· Incorporate into warm up drills prior to martial arts training

· 20 hops

· Will help with

o Dynamic balance

Roll or tumble

· Incorporate into martial arts warm up drills

· 20 tumbles

· Will help with

o Total body agility

o Proprioception

o Reaction to push or fall

SAQ - part 2- Speed

When Bruce Lee developed the martial art of Jeet Kune Do (JKD) he chose to use a hybrid fighting stance; one in which the practitioner faces forward. To increase SAQ, the heel of the back foot is slightly raised, the knees are slightly bent, and the body is slightly crouched (Tom, 2005). This particular fighting stance provides the base from which all techniques are initiated. When observed, the JKD fighting stance resembles a lunge or a split squat. Therefore to develop speed, as determined by movement distance per unit of time or the time taken to cover a fixed distance (Baechle & Earle, 2008), it makes sense to utilize exercises that enhance a lunge or split squat in various settings. For quick acceleration and moving the body as whole rather than individual limbs, increasing stride length and stride frequency will increase velocity.

A split squat jump or a jumping forward lunge will utilize the quadriceps, the hamstring, and the gastrocnemius as well as increase hip power and stride length (Jonhagen, Halverson, & Benoit, 2009; Brown & Ferrigno, 2005). To complete the exercise start in a lunge position, jump straight into the air and return to the original position (Brown & Ferrigno, 2005). The rear knee should remain off of the ground and the hands can be used to help accelerate the upward velocity. Variations can include alternating legs, as well as incorporating forward, backward and lateral movement.

In martial arts, like many sports, there is a need for short bursts of speed rather than a need to reach maximum velocity over a long period of time or distance. Consequently, training for the acceleration phase of sprinting may provide the most benefit. Resisted and assisted acceleration training, particularly hill running, have proven to be successful methods of increasing stride rate and stride length. Running up hill increases stride length and running down hill increases stride frequency. The combination of the two is effective in increasing the maximum running velocity for short distances (Paradisis & Cooke, 2006). However, running uphill may produce altered kinematics that would leave a martial athlete in an unbalanced position. Sprinting up and down stadium stairs provides the same benefits as hill running. Running up will increase starting power and stride length (Brown & Ferrigno 2005) and running down will increase stride frequency while allowing the athlete to remain in an upright position. To increase acceleration, short sprints of four-eight seconds are recommended.

Due to the dynamic nature of a martial arts sparing match, the ability to initiate movement, defensive or offensive, from either the right or left side is critical as is quickly regaining base and balance. Exercises that enhance bi-lateral coordination and limb speed that can be executed from the JKD fighting stance need to be employed. Sorensen, Zacho, Simonsen, Dyhre-Poulson, and Klausen (1996) state that linear movements performed with maximal speed are achieved proximal to distal and in the case of a martial arts front kick the movement starts with the acceleration of the thigh. Furthermore, one method of blocking a kick to the leg, termed “destruction”, involves lifting the knee to intercept the oncoming kick (Cruse, nd). The run-through-hurdle is an exercise that increases lower body ambidexterity, imitates, at least in part, a kick and a destruction, and increases stride frequency. To perform the exercise set eight to ten low hurdles about 3 feet apart. Run over the hurdles with an emphasis on bringing the knee up quickly as well as a quick recovery. The exercise can be performed with one or both feet landing in between each hurdle or to further increase speed, stagger two sets of hurdles; one for each leg (Brown & Ferrigno 2005).

Split Squat – jump lunge:

· Incorporate into lower body strength training program

· 3 sets of 10-20

· Will help with

o Reactive movements

o Keep subject on toes rather than staying flat footed

o Additional incorporated movements will improve dynamic balance

o Increase stride length and power

Stadium Stairs

· Incorporate into conditioning warm up drills

· 5 sets of intervals

· Start with 8-10 seconds fast with 30 second rest

· Will help with

o Increase starting power

o Increase stride rate (down) and stride length (up)

Run through hurdles

· Incorporate into conditioning warm up drills

· 5 sets

· Will help with

o Increase lower body ambidexterity and stride frequency

Intro to Speed, Agility, and Quickness

I know, I know, I know; it has been months since my last posting. Well quality takes time.

The following is the introduction to Speed, Agility and Quickness (SAQ). This is geared toward martial arts, but the principles can be applied to any activity. Included with the intro are the references for all of the sections and an example of how the exercises can be incorporated into a training program (the exercises will also appear at the end of each corresponding posting). There are only a few exercises listed as this is to just give an example of how SAQ can be enhanced. Use your imagination and follow the reasoning behind each exercise.

It has long been known that SAQ are necessary for elite athletics. Sporting activities require fast, coordinated movements of the limbs and/or the entire body (Brown & Ferrigno 2005). By taking advantage of the stretch-shortening cycle (SSC) of muscles (facilitates recruitment of motor units by storing energy during the eccentric phase of an exercise and utilizing it during the concentric phase), SAQ training enhances athletics as well as everyday activity (Vissing, Brink, Lonbro, Sorenson, Overgaard, Danborg, Moternsen, Elstrom et al., 2008; Brown & Ferrigno, 2005). For improvement in a specific movement, Rhea (nd) states that the specifics of the activity need to be closely mimicked, therefore the chosen exercises need to recruit the same muscles, resemble the movement patterns, and use the same velocity as the activity being improved (McBride, Triplett-McBride, Davie & Newton, 2002). Adding appropriate SAQ exercises that mimic specific areas that are in need of improvement into a traditional training program will increase maximal force during high speed movements, increase muscular power in all three planes of motion, as well as increase proprioception and reaction time (Brown & Ferrigno, 2005).

Example Program:

The program outlined below is designed to improve balance, reactive movements, and explosive power for a novice martial athlete. As the subject becomes more adept at the exercise volume and intensity need to be increased. To improve the subject’s endurance, running stadium stairs and jumping rope can be completed for 20-40 minutes or an interval program can be established.

Split Squat – jump lunge:

· Incorporate into lower body strength training program

· 3 sets of 10-20

· Will help with

o Reactive movements

o Keep subject on toes rather than staying flat footed

o Additional incorporated movements will improve dynamic balance

o Increase stride length and power

Stadium Stairs

· Incorporate into conditioning warm up drills

· 5 sets of intervals

· Start with 8-10 seconds fast with 30 second rest

· Will help with

o Increase starting power

o Increase stride rate (down) and stride length (up)

Run through hurdles

· Incorporate into conditioning warm up drills

· 5 sets

· Will help with

o Increase lower body ambidexterity and stride frequency

Jump rope

· Incorporate into conditioning warm up drills

· 3-5 minutes

· Start with 20 seconds fast with one minute of moderate pace

· Will help with

o Timing

o Coordination

o Dynamic balance

o Power

Hop and stick

· Incorporate into warm up drills prior to martial arts training

· 20 hops

· Will help with

o Dynamic balance

Roll or tumble

· Incorporate into martial arts warm up drills

· 20 tumbles

· Will help with

o Total body agility

o Proprioception

o Reaction to push or fall

Directional mirror drill

· Incorporate into martial arts warm up or use as a training drill during class

· 3-5 minutes for warm up (rest every 30 seconds for one minute)

· 15-20 minutes as class drill (rest every few minutes as participants need)

· Will help with

o Reactive movements

o Faster thought processing and anticipatory time

Medicine ball wall toss

· Incorporate into strength training program

· 3 sets of 10-15 tosses

· Will help with

o Total body power

o Punching speed and power

o Reaction time

Plyometric push up

· Incorporate into strength training program

· 2-3 sets of 10

· Will help with

o Upper body strength

o Explosive power

o Quickness of upper body movements

References

Baechle, T. & Earle, R. (2008) Essentials of strength training and conditioning. (pp. 252,)Champaign, IL. Human Kinetics

Brown, L., & Ferrigno, V. (2005) Training for speed, agility, and quickness. (pp. 1-2, 35-36, 53, 63, 72-75, 121-124,134, 139, 143, 156, 157, 167) Champaign, IL: Human Kinetics

Clark M, & Russell A. (2007) Optimum performance training for the performance enhancement specialist. Calabasas, CA: National Academy of Sports Medicine.

Cruse, T. (nd) Jeet Kune Do + Filthy MMA = Paul Vanuk's effective street fighting in 15 minutes. Retrieved from www.blackbeltmag.com/jeet-kune-do-filthy-mma-paul-vanuk-effective-street-fighting-15-minutes/archives/983

Faigenbaum, A. & Mediate, P. (2006) Effects of medicine ball training on fitness performance of high school physical education students. The Physical Educator Fall 2006, 160-167

Foran, B. (2001) Sports conditioning: Modern training for ultimate athletic performance. (p. 8) Champaign, IL: Human Kinetics

Gadeken, S. (1999) Off-season strength, power, and plyometric training for Kansas State volleyball. National Strength & Conditioning Association 21(5), 49–55

Jonhagen, S., Halverson, K., & Benoit, D. (2009) Muscle activation and length changes during two lunge exercises: Implications for rehabilitation. Scandinavian Journal of Medicine and Science in Sports19, 561–568

Salonikidis, K. & Zaferidis, A. (2008) The effects of plyometric, tennis drills, and combined training on reaction, lateral and linear speed, power, and strength in novice tennis players. Journal of Strength and Conditioning Research 22(1), 182–191

Little, J. & Lee-Caldwell, L. (2000) Striking thoughts; Bruce Lee’s wisdom for daily living. (p. 11) Boston: Tuttle

McBride, J., Triplett-McBride, T., Davie, A. & Newton, R. (2002) The effect of heavy-vs. light load jump squats on the development of strength, power, and speed. Journal of Strength and Conditioning Research 16(1), 75–82

Mori, S., Ohtani, Y. & Imanaka, O. (2002) Reaction times and anticipatory skills of karate athletes. Human Movement Science 21(2), 213-230

Paradisis G. & Cooke, C. (2006) The effects of sprint running training in sloping surfaces. Journal of Strength and Conditioning Research 20(4), 767–777

Rhea, M. (nd) Transfer of training to sport performance. Retrieved from www.academics.ashs.atsu.edu/hmvideos/rhea/HM503/transfer.wmv

Sorensen, H., Zacho, M., Simonsen, E., Dyhre-Poulson, P. & Klausen, K. (1996) Dynamics of a martial arts front kick. Journal of Sports Sciences 14, 483-495

Terry, C. (2006) The martial arts. Physical Medicine and Rehabilitation Clinics of North America. 17, 645–676

Tom, T. (2005). The straight lead, the core of Bruce Lee’s Jun Fan Jeet Kune Do. (pp. 25-33) Boston: Tuttle Publishing.

Vissing, K., Brink, M., Lonbro, S., Sorenson, H., Overgaard, K., Danborg, K., Mortensen, J., Elstrom, O., Rosenhj, N., Ringaard, S., Andersen, J. & Aagaard, P. (2008) Muscle adaptations to plyometrics vs. resistance training in untrained young men. Journal of Strength and Conditioning Research 22(6), 1799–1810

Vossen, J., Kramer, J., Burke, D. & Vossen, D. (2000) Comparison of dynamic push up traning and plyometric push up training on upper body power and strength. Journal of Strength and Conditioning Research 14(3), 248–253

Vunak, P. (2001) Anatomy of a street fight. (pp. 23-24) Burbank, CA. Unique Publications.

Winkler, M. (2007) Ropesport; the ultimate jump rope workout. (pp. 13, 152). Hoboken: John Wiley and Sons Inc.

Yaggie, J. & Campbell, B. (2006) Effects of balance training on selected skills. Journal of Strength and Conditioning Research 20(2), 422-428