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Pre-habilitation for the High
School Athlete
Patrick Jenkins MA, ATC, CES
Athletic Trainer
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What is Pre-hab?
• Exercises done with the specific goal of preventing
injuries.
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Why Should We Do Pre-hab?
• Can we really prevent injuries from occurring?
– Role of the physician, ATC, strength coach, & sport coach, student athlete
• How do we determine who is at risk for what?
– Physician & ATC responsibility
• Why should high school athletes do pre-habilitation exercises?
– To prep for intensity of college level athletics – IT IS VERY DIFFERENT!!!
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Why?
• 1 of 6 „Domains of Athletic Training‟ is Prevention
• OVERTRAINING-extended playing seasons beginning at youth levels up through college/university
• 25% of Student Athlete Body are Freshmen
• Tested immediately for strength, speed, power, endurance, vertical, etc – Are they ready?
– “If they aren‟t ready now, when can they be ready?”
– Are we getting a true test of the athlete if they have recognizable dysfunctions?
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Prevention
• What methods are currently in place to prevent
injuries?
– Pre Participation Exam
• Physician & ATC exam
– BP, HR, lungs, vision, basic musculoskeletal scan
– Helmets, mouth guards, padding, etc
– Taping & Bracing
– Acclimatization periods
– Strength & Conditioning
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Limitations • PPE does not currently address athletic movements
• Helmets, mouth pieces, padding, taping & bracing are debatable & don‟t correct potential issues
• Strength & Conditioning can‟t focus athlete development without a functional “unit” – Early recognition for proper training accommodations
• Where does this leave us?
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Movement Screens
• Evaluation tool that can
assess functional body
movements
– Over head squat - OHS
– Single leg squat - SLS
– Push up?
– Running, cutting,
jumping?
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What do we see?
• General weakness
– Hips – flexors, glutes, abductors, adductors
– Hamstrings – flexion of knee & extension of hip
– “Core” – TA, lumbar extensors, internal/external obliques, lats
– Shoulder girdle – rhomboids, mid & lower trap, serratus anterior
• General ROM deficits
– Hips – IR/ER, hamstrings, hip flexors, glutes, abductors, adductors
– Ankles – calves
– Shoulder – pecs, lats, rotator cuff
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Common Findings
• General Injuries
– LBP
– Patellar tendonitis
– Medial & lateral ankle
pain, repetitive sprains
– Shin splints
– Achilles tendonitis
– Repetitive muscle strains
– hamstring & hip flexor
– Stress fractures
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Overhead Squat - OHS
• Knees – move in or out
• Feet – turn in or out
• Feet – do heels raise
• Trunk/hips – flexion
• Lumbar spine – curvature
• Arms – verticality
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Overhead Squat – Baseline Subject
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Example 1
• Freshmen men‟s
basketball player
• 6‟6”, 207#
• 18 month history of B
anterior knee pain
• Persistent low back pain
• History of B ankle
sprains & lateral ankle
pain
• Standing VJ – 29.5”,
Approach VJ – 37”
• ROM deficits – hip flex/ext/er/ir/abd; knee flexion; + B Thomas test
• MMT deficits – hip abd/ext 3+/5; 4/5 knee extension
• TTP at inferior pole of patella
• Pes planus (flat feet)
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Example 2
• Junior basketball player
• 6‟4, 210#
• L periodic quadriceps
tendonitis
• Periodic LBP
• R lateral foot stress
fracture
• Standing VJ – 31.5”,
Approach VJ – 37”
• ROM deficits in hip
ext/flex/ir/er; L
quadricep – knee
flexion; adductors
• TTP at superior L
patellar border
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OHS Assessment
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OHS Rear View Assessment
• Knees move in slightly
• Feet flatten
• Feet turn out
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SLS Assessment
• Trunk rotates towards
stance leg
• Knees move in
• Feet flatten
• Hip drops
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OHS Modified w/ Heel Lift
• With 1.25” heel lift
• Improved knee alignment
• Deeper squat
• Feet don‟t turn out
• Arms don‟t fall as far
• Improved trunk & tibia alignment
• Low back still extends
• Improved balance
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Modified OHS
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What did we find?
• Weak or Underactive
– m. hamstring, m. gastroc,
glute max & med, VMO,
ant. tibialis, erector
spinae, intrinsic core,
post tibialis
• Tight or Overactive
– Soleus, l. gastroc, l.
hamstring, TFL,
adductors, hip flexors,
latissimus dorsi,
peroneals
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Now What?
• After movement analysis determine which
areas could benefit from a pre-habilitation
program
• How to treat findings
– Which exercises for specific areas
– “inhibit, lengthen, active, integrate”
• Progression through plan
– f/u at 4 weeks, 8 weeks, 12 weeks, 6 months, 1 yr
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MBB Plan
• Inhibit (foam roll) - Lateral calf, lateral hamstring, ITBand, TFL, latissimus dorsi, glute
• Lengthen (stretch) – lateral calf, lateral hamstring, TFL, hip flexor, glute, piriformis, latissimus dorsi
• Activate (strengthen) – medial calf, medial hamstring, glute medius/maximus, anterior tibialis, posterior tibialis, erector spinae, intrinsic core
• Integrate (multi joint movements) – athletic lifts & movements to facilitate firing patterns, stabilization, co-contractions
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Inhibit – Foam Roller
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Inhibit – Foam Roller
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Lengthen - Stretching
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Activate - Strengthen
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Integrate – Dynamic Exercise
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Considerations
• Do you have time to evaluate your athletes?
– If you don‟t should you make the time?
• Should athletes with movement screen weaknesses
perform high intensity combination movements
(squats, cleans, plyometrics, etc)?
• Vary exercises
• Incorporate Rest
• Don‟t sacrifice form for weight
– Youth soccer example
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Conclusions
• An ounce of prevention
– Taping, bracing, equipment is not enough
• Incorporate movement screens and then basic exercises for overlooked muscles
• Preparation for next level intensity
• Relative rest