Evidenced Based Functional

Rehabilitation

May 10th 2014

MAATA, Virginia Beach

Michael Higgins PhD, ATC/PT, CSCS

Towson University

Is it becoming stronger?

What is Functional

Rehabilitation/Training?

Is it Becoming Faster?

FUNCTIONAL ?

Is it Becoming More Powerful?

Is it Becoming More Flexible?

Is it Reproducing the Desired

Motion?

Is it Improving Balance?

Is it a Combination of Them

All?• Stronger

• Faster/quicker

• Powerful

• Flexible

• Improving balance?

• Improving neuromuscular control?

• Reproducing the desired motion?

Is it Improving Neuromuscular

Control?

We Have the Technology

Functional Training Defined

• “All functional movement patterns

involve deceleration, stabilization

and acceleration, which occur at

every joint in the kinetic chain and in

all three planes of motion.”

National Academy of Sports Medicine

Functional Training Defined

• An exercise continuum involving balance and proprioception, performed with the feet on the ground and without machine-assistance, such that strength is displayed in unstable conditions and body weight is managed in all movement planes.

• Gray G. (1995) Following a functional path.

Functional Training

• Simply stated, the primary goal of

functional training is to transfer the

improvements in strength achieved

in one movement to enhancing the

performance of another movement

by affecting the entire

neuromuscular system.

Chek Institute

Functional Training Defined

• Multi-joint, multi-planar, proprioceptively-enriched activity that involves deceleration (force reduction), acceleration (force production) and stabilization; controlled amounts of instability; and management of gravity, ground reaction forces and momentum.

• Boyle M. (2003) Functional Training for Sports

Functional Training

• In functional training, it is as critical

to train the specific movement as it is

to train the muscles involved in the

movement. The brain, which controls

muscular movement, thinks in terms

of whole motions, not individual

muscles.

American Council on Exercise

Functional Training Defined

• It must be remembered that

functional training is not an all-or-

nothing concept. A continuum of

functionality exists. The only entirely

functional exercise is the actual

activity one is training for.

Vern Gambetta

Functional Training

• Training to improve functional

strength involves more than simply

increasing the force-producing

capability of a muscle or group of

muscles. Rather, it requires training

to enhance the coordinated working

relationship between the nervous

and muscular systems.

Functional Exercise (Gray)

Non-Functional Functional

Isolated Integrated

Rigid Flexible

Limited Unlimited

Artificial Physiological

Fake Real

Link action Chain reaction

Gravity confused Gravity user

Lab-like Life-like

Mechanical Biomechanical

Deceptive Proprioceptive

1 dimensional Multi-dimensional

Alternate Definition

Functional training involves movements that are specific — in terms of mechanics, coordination and/or energetics — to one’s activities of daily living (ADLs). When considered in these terms, the range of “functional” activities may be broader than commonly thought.

Plisk, S. NSCA Functional Training. Hot Topic

Specific functional vs. Non

functional Exercises: (Chek)

Non-Functional Functional

Bench press Push up

Lat pull down Pull up

Seated triceps extension Dip

Leg extension Lunge

Leg press Squat

Functional Training

• Some individuals believe that by

mimicking the explosive, ballistic

activities of high-level competitive

athletes, they are training in a

functional manner.

Functional Training

• Full spectrum work, in multiple planes, using multiple joints, incorporating full range of motion that is proprioceptively demanding.

• Training that incorporates a full spectrum of training methods, designed to elicit optimum adaptive response appropriate for the sport or activity being trained for.

• No one system of the body is emphasized to the exclusion of another.

Functional Training

• No one training method or physical quality becomes an end unto itself.

• Each athlete is a case study of one–respect the individual.

• Be real – Avoid artificial restraints and positions.

• The goal of functional training is to develop Athleticism, the ability to perform athletic movements (Run, Jump, Throw, & Lift) with sound technique at optimum speed, with precision, style and grace within the context of the sport or activity

Quarterbacks vs. Pitchers

Everyday and Athletic Activity

• Involve skillful application of ground reaction forces.

• Transmit forces through the body’s segments.

• Are performed in multiple planes of motion, often with no machine to guide one’s movement (unlimited degrees of freedom).

• Consequently, we must control, direct and stabilize the mass of our own bodies as well as other objects.

• Tasks, while often repetitive, are usually brief in nature. In fact, rapid “spikes” in force output are the rule rather than the exception.

• In order to achieve the balance and leverage needed to perform these tasks, we regularly get into certain positions. And the more habitually we do so, the more this reinforces corresponding motor programs and functional adaptations.

Plisk S, NSCA Funtional Training

Football and Pitchers

• Upright position of the quarterback causes:

• Decreased contribution from the trunk and legs – result in decreased arm velocity

– No complete follow-through

– Decreased forward trunk tilt.

So What do we do?

Let research, experience and common

sense guide the way.

Rotator Cuff Strength (1-6)

1. Side-lying ER at 0 degrees of abduction

2. Standing ER at 0 degrees of abduction with a towel roll

3. Standing ER at 45 degrees in the scapular plane

4. Open can exercise

5. PNF D2

6. Standing ER at 90 degrees of abduction

7. Prone ER at 90 degrees of abduction

• All of these

exercises have

produced high

amounts of EMG

activity in the

supraspinatus

muscle.

“The Ballistic Six”(7)

• Latex tubing external rotation.

• Latex tubing 90/90 external rotation.

• Overhead soccer throw using a medicine ball.

• 90/90 external rotation side-throw using a medicine ball.

• Deceleration baseball throw using a 2–lb medicine ball.

• Baseball throw using a 2-lb medicine ball.

Shoulder Hurdle Walk Overs

Exercises for Throwers

• Scapular stabs/Serrattus Anterior

– Shoulder slides (slide board/suspension)

• Glut ham I,Y,T & prone row press

• Trunk

• Single leg squat to overhead press

• Rotator cuff

• Triceps off bar

• No monies/W’s

Glut/Ham I,Y,T

Prone Row Rotation Press

Glut/Ham Row Press

D 2 squat

Slide Board Runs

Basketball

• Jump training

• Medicine ball throws

• Overhead squat

• Cleans

• Snatches

Single Leg Squat to Press

Single Arm DB Snatch

Swimming Phases

• Swimming produces less stress and eccentric loading to the joint

• BUT the continuous nature of swimming allows less opportunity for muscular recovery

• Greater risk of fatigue- induced microtrauma to the joint

Pink MM, Tibone JE. The painful shoulder in the swimming athlete. Orthop Clin North Am 2000; 31 (2): 247-61

Exercises for Swimmers

• Trunk

• Shoulder

• Lats (inverted and incline pulls)

• Med ball

• Prone row press

• Strap flutters

• Strap fallouts

Fall Outs

Incline Pull Up (Beginner)

Flutter Fall Outs

Incline Pull Up

Short Flutters

Volleyball Mechanics

Important to Remember

• Leg drive and trunk rotation

(forward/shoulder-over

shoulder/twist) = shoulder speed

Rokito et al.J. Shoulder Elbow Surg,1998

Muscle Activity in Volleyball serve and spike

Volleyball / Tennis

• Med ball jump slam

• Slide board running

• Tubing push up

• Cone walkovers for shoulders

Tennis

• The players with a better leg-drive – uses the inertial transfer from the trunk to upper limb to

move the upper arm into a position of MER.

• Increased leg drive– less internal rotator torque to stop the external rotation.

• Less effective drive– primarily use the external rotators to achieve MER,

– requires a greater internal rotator torque to reverse the rotation of the upperarm.

Tubing Push -up

Jump Medicine Ball Slam

Overhead Band Squat

Medicine Ball Floor Slam

Medicine Ball Warm-Up

Overhead Medicine Ball

Exercises for Lineman

• Hip assault

• Sled

• Med ball burpee

• Barbell corner squat to calf raise to

press

Corner Barbell Squat Press

Lunge with Press

Stability Push-Up Hold

Knee/Hip

Patellofemoral• Single leg squat

• Clam shell

• Lunge

• Cable extension

• Jospt

Stability Push Up

Hip Over

Hip Under

Glut Medius

• Side-lying hip abduction – 81%

• Single limb squat – 64%

• Lateral band walk – 61%

• Single-limb deadlift – 58%

•

Single Leg Squat

Single Leg RDL

Hamstring

• Glut activation

• Glut ham raise

• Single leg bridge

• Single leg RDL

Glut Max

• Single-limb squat – 59%

• Single-limb deadlift – 59%

• Sideways, front, and transverse

lunges – 41-49%

DiStefano, L. (2009). Gluteal Muscle Activation During Common Therapeutic Exercises

Journal of Orthopaedic and Sports Physical Therapy DOI: 10.2519/jospt.2009.2796

Trunk

• Med ball

• Planks

• Cable planks

Two Band Planks

Tricep Extensions

Cable Planks

Band Planks

References

1. McCabe, R.A., K.F. Orishimo, et al. “Surface electromyographic analysis of the lower trapezius muscle during exercises performed below ninety degrees of shoulder elevation in healthy subjects.” North American Journal of Sports Physical Therapy 2 no. 1 (2007): 34-43.

2. Reinold, M.M., Escamilla, R, Wilk, K. Current Concepts in the Scientific and Clinical Rationale Behind Exercises for Glenohumeral and Scapulothoracic Musculature. Journal of Orthopaedic & Sports Physical Therapy 39 no. 2 (2009): 105-117.

3. Blackburn T, McLeod W, White B, Wofford L. EMG analysis of posterior rotator cuff exercises. J Athl Train. 1990:25:45.

4. Reinold, M.M., L.C. Macrina, et al. “Electromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises.” Journal of Athletic Training 42 no. 4 (2007): 464-469.

5. Reinold, M.M., K.E. Wilk, et al. “Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises.” Journal of Orthopaedic & Sports Physical Therapy 34 no. 7 (2004): 385-394.

6. Takeda, Y., S. Kashiwaguchi, et al. “The most effective exercise for strengthening the supraspinatus muscle: evaluation by magnetic resonance imaging.” American Journal of Sports Medicine 30 no. 3 (2002): 374-381.

7. Carter, A, Kaminski, T, Douex, A et al. Effects of high volume upper extremitymplyometric training on throwing velocity and functionalmstrength ratios of the shoulder rotators in collegiate baseball players. J. Strength Cond. Res. 21(1):208–215. 2007.

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