”Form follows function” Louis Henry Sullivan said in 1896. “Everybody who performs an athletic event is a system of levers. You can’t alter what the bones do…It’s when guys are in a bad position and now try to make the muscles do something to compensate for the bad position that they injure themselves.” Sandy Koufax
Most treatments for musculoskeletal pain focus on treatment of the SITE of symptoms. By taking a symptomatic approach instead of addressing the SOURCE of pain recurrences are common. To address the SOURCE of pain it is necessary to understand:
- THE ACTIVITY HISTORY – What activities are compromised by pain or weakness – i.e. your activity intolerances or participation goals in your home, work, or sport activities
- THE FUNCTIONAL EXAMINATION – What functional deficits you have that may be related to 1 (inlcuding mobility, stability, endurance, coordination, balance, strength, speed, power)
Most pain management approaches focus on symptomatic relief via medication, injections, surgery, physical therapy modalities (ultrasound, electrical stim, laser), massage, chiropractic adjustments, acupuncture, etc.. Most rehabilitation therapy focuses on isolating weak or tight areas & exercising them on the floor, with machines or in isolated ways.
Functional training is different in that it focuses on fundamental movements of daily life, occupation, sports or recreation such as squats, lunges, pushing or pulling instead of isolated training of individual muscles such as biceps curls or leg raises. Functional training is often performed with body weight alone, but dumbells, bars, kettle bells or sandbags can be added. In contrast to isolated, individual muscle exercises which are performed on the floor or with machines functional exercises are usually trained in upright positions and involve movements in multiple planes of motion simultaneously just like in sport (i.e. golf, throwing, tennis, etc.).
What are some examples?:
Transverse Arch Training – forward lean -upright plank
Squats (overhead, jump, Sumo, etc.)
Functional & Balance Reaches
Posterior & Anterior Hip Capsule Mobilizations
Frontal Plane training (Gluteus Medius, Farmer’s Walk, lateral steps)
Closed Chain Upper Quarter – push up w/ +
Star Lunge w/ Push (w/ & w/out resistance)
Star Lunge w/ Pull (w/ & w/out resistance)
Vertical & Horizontal Jumps
Hip assessment is one of the most important components of functional training.
Assessing the posterior chain to determine if quad dominance is present can be performed by evaluating floor bridges (2 & 1 leg); ball bridges (up/down & curls 2/1); squats; & 1 leg squats.
Single leg balance assessment eyes open & closed is important
Janda’s hip abduction test is one of the most useful tests as it gives an indication regarding muscle imbalance around the hip-pelvis region involving gluteus medius (tends to inhibition); piriformis, adductors, psoas, & QL (tend to shortening or substitution)
Checking a person’s functional squat can indicate poor stability of the lumbar spine (excessive kyphosis) or the knee (medial collapse). Here we see examples of a youth baseball player assuming the “short stop” position.
Other useful functional tests include:
- 1 leg squat (step, pistol, etc.)
- 1 leg box squat
- reverse lunge slide
- reverse lunge step
- angle lunge
- split squat
- supported functional reach
- balance reach
- lateral band walk
A common painless dysfunction encountered when working patient in single leg stance is medial collapse of the knee. Knee valgus position in sport is NOT a problem. It is poor control of knee valgus or excessive knee valgus. For instance, in a female basketball or soccer player landing on one foot with the knee in uncontrolled valgus is a mechanism of injury for the ACL
How would a trainer/coach determine whether the amount of valgus they see during landing is in excess?
The drop jump test is one useful procedure – http://www.craigliebenson.com/?p=534 -. Also, 1 leg squat performed from a stair step to the step below. If the knee rotates inwards so that it is medial to the foot that is excessive. Tim Hewett’s work on this topic is excellent. Also, FIFA has an 11+ training program that is available for free on their website & the final picture shows the valgus overload position on a single leg squat – http://www.elitesoccerconditioning.com/InjuryPrevention/FIFA%2011%20poster(new).pdfVern
There is a tendency to overanalysis sport performance & Vern Gambetta warns, “Why make it so complicated? The body does what it needs to do to solve the movement problems presented to it. Train to reduce & produce force and improve proprioception. Simplicity yields complexity.”. Pr. Janda taught “every exercise is a test”. Find each patients “weak link” and train them at the edge of their capability. This will maximize neural adaptation and motivation.
“I like it to teach people femoral control and the relationship to what happens to thier foot when their hip shuts off (in the valgus position). I like them to feel the unstale position and the stable position. I like to introduce rotation. I like the concept of eccentric external rotation versus concentric internal rotation, for decleration education purposes.
Keep in mind, when watching a 1:30 video, you are not going to see the entire context of an exercise.” Sue Falsone
It is not advisable to train in valgus collapse of the knee. But, in sport this occurs regularly. Beginning in a valgus position without load as Sue is doing it and then resisting the correction is very functional. I typically start neutral & go into correction, but both ways can be functional.
The key is to have CONTROLLED eccentric loading into a valgus position. Think of the picture of Ricky Henderson leading off a base. The valgus position occurs regularly, but acceleration requires that it is controlled. Training it’s control is different than training into valgus overload. And, this is where we are loading to unload or “cocking the trigger”. Winding things up can be very helpful. But, this is where a strict follower of Gary Gray can go overboard especially when they get their hands on a med ball & work the spine in full flexion under load. Here we see a pistol squat with compensatory lumbar flexion due to insufficient posterior capsule hip mobility.