Saturday, September 21, 2013

Saturday Studies

It's Saturday and a great day to start a new little series where we highlight interesting studies and research we've come across. 

In the ever evolving world of Sports Performance it is extremely important to know how to read literature and take away information from research. 

The term evidence-based practice is becoming more and more popular, essentially meaning, does what you're doing have evidence behind it to support it.  Is your training program just thrown together without much thought, or is there valuable research out there to support and verify what you are doing actually works and is effective. 

I think being in the loop with research is extremely important, but I also understand many studies and research are flawed.  Their set-up is weak, their controls are poor, they use untrained subjects, the duration of the studies are short, many don't understand exercise technique or realistic programming, and it's very easy to mistake correlation for causation. 

They're needs to be a good balance between research based practice and experience based practice.  If you've been in the trenches for some time, you know what works and don't need research to tell you so.  Research hasn't covered everything, and has missed the boat on some important areas, and just because research hasn't supported something is not a good reason to not use it if you see results. 

Ok let's look at 2 studies for today

1. Fear of re-injury (kinesiophobia) and persistent knee symptoms are common factors for lack of return to sport after anterior cruciate ligament reconstruction.

Suffering from an ACL injury can be devastating to an athlete.  I can't speak for every having one, but knowing plenty of people who have, it's easy to point out the major differences in how people emotionally respond to the injury. 

With improving surgery techniques and rehabilitation protocols, some athletes can see full return in as little as 9-12 months.  Go back about only a decade and an ACL is an 18-24 month rehab, and for some career ending. 

BUT with this increased push for faster recover, and individuals out there re-defining the rehab process (Adrian Peterson), the pressure is there for athletes, especially high level athletes to get back faster and faster. 

This studied interviewed 135 post-ACL surgery patients varying from recovery time of 12-24 month post-operation.  Now the short comings of this study rear it's head in the fact that not many of these people were actually serious athletes the rehab protocols are not specific, and it consisted of phone interviews. 

Of the 135 subjects, 46% returned to pre-injury activity level, while 54% did not.  The researchers focused on the 54% that did not.  They were questioned why not, and the top response was due to persistent knee pain, instability, and stiffness.  The second reason was fear of re-injury.  In fact, 52% of those who had not returned to pre-injury activity levels said fear of re-injury was the reason they had not returned yet. 

This is important because, there is really not a psychological standard for rehab and this might give way to not only retraining the body, but also retraining the mind.  This is something that has been known for years, but it's give support to re-thinking the rehab process a little bit. 

Take no look further than RG3 and Derek Rose.  Anybody who has watched RG3 thus far this year can see he's not himself and doesn't trust his knee.  Now he'll tell you he's not worried about it, but his actions speak louder than his words.  Derek Rose sat out this past years off-season because of fear of re-injury.  He was cleared by doctors, meaning his body and biomechanics were ready to go, but his mind wasn't. 

So all in all, this study supports maybe adding another aspect to ACL rehab, a mental component.  One that caters to the unique personality type and re-trains the brain and mind to getting back in action.

2. Muscle Activation Levels of the Gluteus Maximus and Medius During Standing Hip Joint Strengthening Exercises Using Elastic Tubing Resistance

This study looked at how 4-way band hip work activated the various hip and glute musculature.  We all know how important the hips and glutes are for performance, but also know weak hips and glutes are associated with a number of lower limb injuries and dysfunctions. 

The 4-way band hip work is extremely common in rehab settings, but this study looked to see if they were actually effective.  They used 26 college aged individuals and had them perform 3 sets of the band work in each direction. 

What they found was that no direction managed to activate the hip and glute muscles in a large enough manner to effect strength gains through EMG.  It is thought that 50% of MVC (max voluntary contraction) is needed to elicit strength work, but this 4-way hip work did not achieve that number.

Let's look at some flaws in this study.  First no technique was discussed, and in the 4-way hip exercise technique is imperative to get proper results.  Secondly they used bands, and the resistance level of these bands is not specified, but we might guess that the resistance level was not high enough to register higher muscle activation.  Lastly they used college aged participants, which is great for many strength and conditioning studies, but I personally feel the 4-way band exercise is more of a rehab or clinical type of exercise that pertains more to post-operation or older people.

Personally I feel the a 4-way hip movement can be effective, but technique and teaching is important.  It is easy to hyper-extend the lumbar spine to make up for glute involvement, and it's also easy for the hamstrings to be over-active if the glutes aren't cued properly.  But on that note, I would most definitely start with closed chain movements such as glute bridges, hip thrust and then advance to reverse hypers, bird-dogs, and quadruped hip extensions before doing 4-way hip.  But many patients or clients cannot get into the positions needed for those exercises, so the 4-way hip becomes the go-to exercise.

Go Get 'Em!

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