Case Study of the Week- Re-building an athlete

Updated: Mar 13

WHO- Mitch M

  • Mitch is a 17 year old high school football player who came to me to rehab an ACL tear. After also tearing his MCL in his left knee, Mitch was on his second ACL surgery in his right knee. His injury was a non-contact injury sustained during cutting in football practice and his Dad brought him to me with the specific request of improving his footwork to prevent this from occurring again.

While this may conjure sessions focused on running mechanics and long, arduous drills versus strength training or mobility, one reason I love movement screening and specific testing is that it allows us to break down the body to understand exactly where strengths and weaknesses lie. This becomes much more apparent in activities which require excessive volume (distance running, triathalons, etc) or intermittent bouts of intensity (football, hockey, soccer, etc) which challenge the body’s physical capabilities.

The basic formula is that the more intense or volumus (made up word) the activity, the more accurate the movement screen and specific performance testing becomes due to the fact that the athlete is no longer able to compensate for their imbalances (or as one of my mentors puts it “hide their lies”)

In Mitch’s case, his two passions are football and weight lifting. With a 300lbs bench press and 250lbs power clean, Mitch is an extremely powerful athlete in many respects however when asked to do a bodyweight chin up he could only rep out six without stopping. Without getting too far in to Mitch’s evaluation, he is what one may expect of a motivated athlete in his sport (extremely over powered in “pushing” while under powered in “pulling”)

Add to that his movement screen and we can confirm several things:

  1. ASLR- 1/2 Shoulder mobility- 1/1

  2. Plank- 1- No core/Low back Glute bridge- 2/1 SL stance- 2/2 Overhead squat- 1- Poor ankle mobility Passive testing- Everything was fairly stiff but in particular poor hip internal rotation on right ACL side as well as hip flexion bi-lateral

Mitch also suffered from fairly frequent bouts of debilitating of back pain which led me to several conclusions for his first four week program:

  1. Stop bench pressing, back squatting and other anterior dominant exercises which worked the front of his body. These would be replaced by a higher volume of pulling exercises as well as the “chin up” as his main lift to improve his pulling ratios.

  2. Place a basic core training program (anti-extension, anti-lateral flexion, anti-rotation, anti-flexion) alongside ASLR corrections to provide proximal stability and lower body mobility

  3. Priority placed on uni-lateral exercises and a “tempo” pace to build stability/control

The basic idea here is to re-establish a base of movement and proximal stability to allow Mitch to better control his body in space. Also notice that I didn’t mention running mechanics, jumping drills, etc. These are more “advanced” items that will come later as we take these major issues off the table.

For those interested in training, I like to refer to Al Vermeil’s Hierarchy of Athletic Development as a standard model of where to begin in the face of so many potential choices.

While today’s example is a more performance based program, I started Mitch’s core training from literally doing wall planks to teach a neutral spine and gradually progressed to lower surfaces until he could perform a single leg plank on the floor. I also cued deep breathing and blowing rather than holding for time in each position to demonstrate cooperation of the deep core muscles. Mitch was very “extremity” dominant as many power athletes and it is important to cue slow, gentle movement to ensure the stabilizers (or “tonic” muscles) are being engaged versus the body’s prime movers (or “phasic” muscles)

With this in mind, Keith’s initial program looks like this:

1. Referral - None

2. Alignment homework - None

3. Gym program:

  • Passive Mobility - Crocodile breathing - Roll- Foot, calf, hip with ball, T-spine w/peanut, lats - Voodoo floss band- None - Band distraction/stretch- PNF Hamstring stretching

  • Active Mobility- 3 x 6-12 breaths per exercise (Progress to harder exercise at 12 breaths) - Leg lowering - Half kneeling hip extension - Plank- Elbows on wall progressing to floor - Side plank- Overhead band hold progressing from bent to straight leg side planks- Bird dog - Hip lift progression

  • Training program - 3 x 8-12 per exercise - A1- Chin up - A2- Single leg - B1- One arm floor Dumbbell press - B2- Split squat progressing to single leg squat


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