The Core: Testing and Training for the hockey player. Joe Eischen PT, ATC, SCS, CSCS Mayo Clinic Sports Medicine Center ©2013 MFMER | slide-1 What is the Core? • Passive subsystem: • Spinal ligaments. • Facet articulations. • Limited load=10 kg. • Muscular subsystem: • Local group. • Global group. • Guy wires. • No one important muscle. • Contribution is dependent upon the magnitude and direction of trunk loading. • Cholewicki and Van Vliet: No single muscle group contributed more than 30% to lumbar stability no matter what the task. • Neural subsystem: • Continuous monitoring from muscle spindles, Golgi tendon organs and spinal ligaments. • Requirements for stability can change instantaneously. • Directs tensioning of guy wires. ©2013 MFMER | slide-2 What is the Core? Muscular subsystem • Local Muscular Stabilizers: • Primary: • Transversus abdominis • Multifidus. • Secondary: • Internal oblique. • Medial fibers of the External oblique. • Quadratus lumborum. • Diaphragm. • Pelvic floor muscles. • Illiocostalis and longissimus (lumbar portions). ©2013 MFMER | slide-3 What is the Core? Muscular Subsystem • Global Muscular Stabilizers: • Rectus abdominus. • Lateral fibers of the external oblique. • Psoas major. • Erector spinae. • Illiocostalis (thoracic portions). • Some say we should not divide core muscles into local and global stabilizers. They all work together. ©2013 MFMER | slide-4 How are we put together? • Mobility stacked upon stability: • Mobile GH joint. • Stable scapula. • Mobile thoracic spine. • Stable lumbar spine. • Mobile hips. • Stable knees. • Mobile ankles. • Extensive MSK evaluation: • Look for limits or stressors above and below the spine. • What is throwing gas on the fire??? ©2013 MFMER | slide-5 How do we test it? • Sahrmann: • 5 levels of progression. ©2013 MFMER | slide-6 Testing • McGill • Plank testing. ©2013 MFMER | slide-7 Testing: McGill • Nesser, Lee. The Relationship Between Core Strength and Performance in Division 1 Female Soccer Players. Journal of Exercise Physiology. Vol. 12, No. 2, April 2009. • 16 female soccer players. • Tests: • Counter movement vertical jump. • Shuttle run. • 40 yard sprint. • 1RM squat and bench press. • McGill plank testing. • No significant correlations were identified between core strength and strength and power. • Core strength does not contribute significantly to strength and power and should not be the focus of any strength and conditioning program with the intent to improve sports performance. • Discussion: • McGill’s tests specifically look at muscle endurance utilizing slow twitch muscle fibers. • The tests involved 1 repetition explosive drills or exercises utilizing fast twitch muscle fibers. • Static measurement versus dynamic movement. • N is very small. ©2013 MFMER | slide-8 Testing: • Gray Cook: • FMS (Healthy)/SFMA (Injured): • 7 tests. • 0-3 grading system. • 0=pain with movement pattern. • 3= perfect movement pattern. • Mobility and stability issues? • 46 NFL football players of a single team. • Score of 14 or less on the FMS was predictive of serious injury during that season. • Specificity of 0.91 • Sensitivity of 0.54 ©2013 MFMER | slide-9 How do we test it? • Prone instability test: • Part of clinical prediction rule for lumbar stabilization: • <40 years old. • SLR > 91 degrees. • Aberrant spine movement pattern. • + prone instability test. • Bridging with knee extension test: • Test of proper gluteal activation. ©2013 MFMER | slide-10 Continuum of Training -Injury to performance…. • Train 3 planes of motion: • Sagittal plane flexion and extension. • Frontal plane. • Transverse plane. • Mat-based training. • Physio ball training. • Unilateral training. • Weight bearing training. • Base of support. • Unilateral drills/exercises. • Performance. • Development of power and explosiveness while maintaining core control. ©2013 MFMER | slide-11 Core Training and Injury… • Core endurance is more important in injury prevention and rehab. • Type 1 muscle fibers which require only low loads to improve performance. • Performing trunk exercises on a physio ball results in significantly increased activation of the lower abdominal region. • But, there are studies showing it does not change activation…. • Unilateral use of upper extremities while on a ball or bench results in even greater activation of core musculature. • However…. • When performing exercises on a ball, force production in the upper and lower extremities is significantly reduced. ©2013 MFMER | slide-12 Common presentation in the hockey player: • Lower cross syndrome: • Huge issue with many hockey players: • Tight hip flexor. • Weak glutes. • Tight low back. • Weak abdominal muscles. • Remember the paper on the need for hip rotation and rotational sports….. • Increased thoracic kyphosis (upper cross syndrome): • Lack of thoracic extension. • Tight pectorals and Lats. • May focus stress on lumbar spine. • Remember our wall Lat test….. ©2013 MFMER | slide-13 Core Training and Performance…. • Can we improve performance by training the Core? • 24 Elite high school Norwegian handball players. • 14 performed sling exercise training. • Similar to TRX training. • 10 players in control group • Both groups performed regular handball training x 6 weeks. • Maximum throwing velocity improved by 5% in the SET group. ©2013 MFMER | slide-14 Core Training and Performance…. • Can we improve it? • Purpose: • Is there any difference in hip strength among golfers with different proficiency levels. • What is the relationship between hip strength and golf handicap. • What is the relationship between hip strength and self-reported driving distance. • 82 golfers. • 10-19 handicap. • 0-9 handicap. • Scratch or better. • Measured isometric hip abduction and adduction in side lying using a hand-held dynamometer. • Scratch or better group was found to be significantly stronger in left hip strength as well as all hip movements tested. ©2013 MFMER | slide-15 Training the Core: • Educate the Athlete: • Understand the task. • Feel the proper pattern. • Train the proper pattern. • Own the proper pattern. • See it, Feel it, Do it! ©2013 MFMER | slide-16 Training Progression: ©2013 MFMER | slide-17 Bibliography • Willardson. Core Stability Training: Applications to Sport • Yung-Shen, Myers, McCrory, Laudner, Pasquale, Lephart. The Conditioning Programs. Journal of Strength and Conditioning Relationship between Hip Muscle Strength and Golf Research. 2007, 21 (3), 979-985 Performance. Medicine and Science in Sports and Exercise. Vol. 36(5) Supplement, May 2004. • Parchmann, McBride. Relationship Between Functional Movement Screen and Athletic Performance. Journal of • Saeterbakken, Tillaar, Seiler. Effect of Core Stability Training on Strength and Conditioning Research. Dec 2011. Vol. 25, No. Throwing Velocity in Female Handball Players. Journal of 12 Strength and Conditioning Research. Vol. 25, No. 3, March 2011. • Kibler, Press, Sciascia. The Role of Core Stability in Athletic Function. Sports Med 2006/ 36 (3):189-198 • Van Dillen, Bloom, Gombatto, Susco. Hip rotation range of motion in people with and without low back pain who participate • Behm, Drinkwater, Willardson, Cowley. Strength and in rotation-related sports. Physical Therapy in Sport 9 (2008). Conditioning Journal. Vol. 33, No. 3, June 2011. • Lust, Sandrey, Bulger, Wilder. The Effects of 6-Week Training • McGill. Core Training: Evidence Translating to Better Programs on Throwing Accuracy, Proprioception, and Core Performance and Injury Prevention. Strength and Conditioning Endurance in Baseball. Journal of Sport Rehabilitation, 2009, Journal. Vol. 32, No.3, June 2010. 18, 407-426. • Shinkle, Nesser, Demchak, McMannus. Effect Of Core Strength • Aroskoski, Valta, Airaksinen, Kankaanpaa. Arch Phys Med On The Measure Of Power In The Extremities. Journal of Rehabil Vol 82, August 2001.Ekstrom, Donatelli, Carp. Strength and Conditioning Research. Vol. 26, No. 2, February Electromyographic Analysis of Core Trunk, Hip, and Thigh 2012. Muscles During 9 Rehabilitation Exercises. JOSPT, Vol 37, No. 12 Dec 2007. • Faries, Greenwood. Core Training: Stabilizing the Confusion. Strength and Conditioning Journal. Vol. 29, No. 2, April 2007. • Parenteau-G, Gaudreault, Chambers, Boisvert, Grenier, Gagne, Balg. Functional movment screen test: A reliable screening test for young elite ice hockey players. Physical therapy in Sport. • Willardson. Core Stability Training for Healthy Athletes: A 15 (2014) 169-175. Different Paradigm for Fitness Professionals. Strength and Conditioning Journal. Vol. 29, No. 6, Dec 2007. ©2013 MFMER | slide-18 Bibliography • Peate, Bates, Lunda, Francis and Bellamy. Core strength: A • Anderson and Behm. Maintenance of EMG Activity and Loss of new model for injury prediction and prevention. Journal of Force Output with Instability. Journal of Strength and Occupational Medicine and Toxicology 2007, 2:3. Conditioning Research. 2004, 18 (3). 637-640. • Kiesel, Plisky, Voight. Can Serious Injury In Professional • Mori. Electromyographic activity of selected trunk muscles Football Be Predicted By A Preseason Functional Movement during stabilization exercises using a gym ball. Screen. North American Journal Of Sports Physical Therapy. Electromyography and Clinical Neurophysiology. 2004, 44(1): August 2007, Vol. 2, No. 3. 57-64. • Parchmann, McBride. Relationship Between Functional • Cholewicki, Van Vliet. Relative contribution of trunk muscles to Movement Screen And Athletic Performance. Journal of the stability of the lumbar spine during isometric exertions. Strength