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Squat with Heel Push. Over-emphasized Cue from Trainers and Strength Coaches Contributes to Achilles, Knee, and Low Back Injuries
Are you an athlete looking to increase your leg strength, power and explosiveness? Are you mom or female exerciser working out in the gym and hoping to firm up your legs and improve a jiggly butt and reduce the visibility of cellulite on the back of your thighs and butt?
To keep up with the latest from Zig Ziegler, follow Zig on twitter @zig_ziegler.
If you look around the internet at various training websites including youtube videos, you will hear numerous experts explain proper squatting technique touting squat technique as the answer to your dreams. The truth about fitness is that there is only one squatting technique. The best technique for squatting is the one you were born with and used until a fitness expert tried to instruct you, you read an article in a fitness magazine, or followed the advice of a friend.
If you watch children up until the age that they begin organized training, their bodies develop at a rate in which we perceive is balance between strength and flexibility. Coordination, however, takes a while to catch up for those children of all ages who experience a growth spurt or constant changes in activity.
In fact, a developing toddler to adolescent is capable of demonstrating strength and flexibility while constantly battling coordination mainly because they have no perception of failure or understanding of instructions given to them on how to walk, run, squat, or throw. They just do it. In fact, the first signs of struggle we see from children while performing physical activities is after their first words of instructions.
Recently i began to instruct my teenage daughter on how to play a new sport. The more practice and instruction I provide, the more she struggles. The more I allow her body to do what she does naturally, the better her performance and the better the result. My goal is to provide her with the strength, balance, coordination, and flexibility to assist her body in performing the task and allow the skill to benefit from her body having the strength, coordination, and flexibility to perform the skills necessary to play the sport. With those things, I am instructing around one weakness or another.
Have you ever heard a strength coach or a fitness professional say, you’re going to struggle until you learn proper squatting technique. I’m glad no one sad that the kid in the pictures. Who knows how long it would have taken him to get up and move on to the next toy. Over the next few minutes I hope to shed a little light on a topic that has finally started to negatively impact, sports, fitness, and life.
I wanted to keep this post brief with the idea of making several points. Here’s how the body works when you perform a squat or for that matter any task on your feet:
1. The first segment of the body to store absorb, and transfer forces absorbed from the ground is the big toe on both feet while performing any activity while standing, walking, running, jumping or lunging. That force is transfer through the joint between the big toe and the foot (the interphalangeal joint). This is the first joint to store and release energy into the entire foot as it passes through the foot and ankle. As forces pass through the toe, it is the bottom of the foot (not the top) that must properly absorb the force and pass it on to the ankle.As a result of forces applied to the ground, the soft tissue of the bottom of the foot contracts and releases efficiently in order to properly move the forces out of the foot or injury may occur.
2. The next segment of the body to absorb, store, and transfer energy is the entire lower leg. The muscles which must first absorb the force as it comes out of the ankle is the gastrocnemius/soleus complex (posterior compartment of the lower leg also knows as the calves) but only after the force passes through the Achilles tendon which connects the ankle to the posterior (back) lower leg muscles.
3. The gastroc/soleus provides the necessary muscle contraction to transfer the forces properly out of the lower leg and next segment, the femur and the muscles of that segment which begins with the hamstrings and glutes. The glutes and hamstrings help to stabilize the pelvis and put it into position to complete the entire squat. The quadriceps act as a stabilizer and help to extend the knee during when elevating the body from the squat position. The quadriceps are triggered to extend the knee and are stimulated by any other anterior muscle contraction in the lower leg or foot.
In the 1960s/1970s/1980s and even the early 1990s, weightlifting was done primarily by body builders including Arnold Schwarzenegger. The legendary body builders focused on squatting through the forefoot. In the mid 1990′s some so called expert (no one will ever take credit for it now) began to instruct people to squat, lunge, leg press, etc while pushing through the heels of the feet. In fact, if you watch just about every fitness video, or so called expert in glute training, every one stresses pushing the the heels.
Here’s a test for you to run through your common sense meter. Perform a toe raise by shifting the weight towards the heels. In performing toe raise, notice the increase intensity in your quadriceps contraction and some contraction of your glutes. Shift the weight into your heels by raising your the entire front part of your foot off the ground, step, or where ever you are doing this test. In doing so you may feel a some contraction in the glutes.
However, you should notice that the more you try to squeeze your qlutes, the more you squeeze your qaudriceps (thighs) instead.
Earlier, I mentioned the role of the big toe. If the weight is in the heel, what happens to the big toe? It lifts off of the ground as the top of the foot and toes extend upwards, initiating the front side contraction of the entire leg.
Now try this test. Perform a standing calf raise (heel lift). As you lift your heel, try to contract your glutes (squeeze your butt). Were you successful? If you were, your kinetic chain and kinematic sequence are correct. Your kinetic chain and kinematic sequence are easily explained as the flow of energy and order (sequence) of muscle contraction.
What you feel here is the muscles contraction and areas of intensity you should feel when are at the top of your squat. While in performing the heel raise, you should have noticed a significant difference in muscle contraction on the calves, hamstrings, and glutes.
But is the contraction greater or less than the Toe Raise (heel press) rather than the Calf Press (heel lift).
In Biomechanics and Kinesiology, in order to push through the heels a person must first shift the weight backwards. To do so, requires a contraction of the muscles on the front of the lower leg. In EMG research testing in my lab, the entire anterior compartment of the lower leg (shin) contracts once the weight shifts behind the mid point of the foot.
The gastroc/soleus complex also contracts but only acts more as a stabilizer than a primary mover. This means the calves neither receive nor deliver any force to the middle of the foot or the big toe when pushing through the heels. In other words if the weight is in the heels and the lifter pushes through the heels, the entire front of the leg contracts to help with the squat. NOT THE BACK OF THE LEG!
As a result of the single exercise cue “Push through the heels” sports and fitness professionals have inadvertently contributed to an increase in Achilles tendon injuries, knee injuries, low back pain and injuries, tight hips, and numerous other injuries. It’s time for a change in the industry and it starts with exercise professionals. I have come to that conclusion based not on opinion but after evaluation of the Biomechanics data of over 50,000 athletes and exercisers over the past 18 years.
By the repetition and migration of injuries to different parts of the body, it’s easy to conclude that many professional athletes like Greg Oden, Tiger Woods and others were instructed to push through their heels while squatting and lunging during rehab. Because it is clearly a cue given as an industry standard, I can imagine that even Chicago Bulls guard Derrick Rose, as he rehabs in hopes to return to play this season has been repeatedly instructed to push through his heels. Even though Adrian Peterson had an incredible 2012 NFL season, he still exhibits signs of a weakened left foot and left ankle demonstrating that he may have been pushing through his heels while training.
Here’s the problem: When you apply force back into the heels, you disable the foot and ankle’s ability to resist internal tibia (lower leg) rotation. In doing so, the athlete’s body is inadvertently ENABLING that same rotation that the foot could be preventing. It is that rotation that cause stress in the Achilles tendon and may cause medial and even lateral knee pain. In addition, the same rotation is what contributes to patella femoral syndrome and can lead to patella tendon ruptures. In previous chapter, I discussed Greg Oden’s injuries and what could have been done to prevent all of his injuries from 2008 to present. It is this simple cue that may have contributed to his repeated injuries. I am able to conclude this because of the presence of rotational stability issues in while he performed running and squatting Biomechanics tests. Brandon Roy, currently signed to play for the Minnesota Timberwolves also exhibited signs of rotational instability. And in numerous exercise videos on the internet Roy can be seen showing those same signs of knee rotational instability due to weight in his heels in various youtube videos. Later in this book, I will share research data from over 1,000 individuals performing squats and other exercisers in evidence of my findings.
Personally, I used to recommend pushing through the heels, as well. In fact, in my early days in the industryI used it as a common exercise cue believing what at the time made sense. However, looking back, my reason for suggesting it didn’t make “common” sense and as I began to apply more of the principles of Kinesiology, I knew I needed to change many of my exercise cues which came from the still evolving fitness industry. From 1997 on, I advocated mid-foot striking while on long distance runs and mid to forefoot pressing while performing strength training and conditioning. I switched to this cue as a way to allow the body to develop and utilize the foot as it was intended: a shock absorber. In order for the foot to assist in absorbing shock with high, low, or no impact activity, the forces start at the segment nears the end (distal) part of the foot, not in the heel.
As a former hurdler, I NEVER ran on my heels. However distance runners (more in the US than other countries) were instructed to run with a heel strike. Here’s a common sense question, if pushing through your heels help increase glute muscle contraction, wouldn’t distance runners have large glutes and strong hamstrings? In addition, would sprinters (who incidentally run on the balls of their feet) have small glutes and stronger quads when compared hamstrings? Instead, its just the opposite. Distance runners have large quads and non-existent glute muscle development when compared to sprinters.
The bottom line is time for a change in this simple cue. Please stop instructing clients to push through their heels unless you are trying to develop strong anterior (front side) leg muscles. Because as a cue to develop more glute strength or get rid of cellulite on the butt, it’s just not gonna happen.
This is an excerpt from my upcoming book: Absolute Kinetix: Fitness From the Ground Up. To be added to the list to receive a copy of the book, post a comment or reply to this article or send a tweet mentioning Absolute Kineix: Fitness From the Ground Up! @zigSports.
Zig Ziegler, The Sports Kinesiologist can be followed on Twitter @zig_ziegler and on http://www.facebook.com/iwannabeaworldclassathlete
What a crazy last 12 months in the NBA. Brandon Roy is coming back! When I wrote about Brandon Roy coming back from retirement in April, some readers responded in disbelief. “He’s got bone on bone,” they said. “I must have been on drugs”, one commenter said. “No credibility”, and so on. Well this is not an I told you so follow up, but more about how Greg Oden can get there too. (Blog coming soon about Brandon Roy’s chances of staying healthy: stay tuned).
After a whirlwind last 6 months or so, Greg Oden was released and gave a lengthy interview discussing his career and life with Mark Titus of Grantland. According to published reports, Greg also began a rigorous rehab and conditioning program to help get his body right. In addition, Greg also reportedly underwent a surgical procedure to help reduce pain in his knee.
The reason you’re here is to find out if and how it might be possible for Greg Oden to make a return as well. I am a fan of Greg as a person and want to see him on the court and achieve his basketball dreams.
My biggest motivation for writing about Greg Oden and other athletes issues is to bring light to the fact that proper treatment of the ‘root cause of any injury is an essential component to helping prevent athletes and anyone from suffering from an injury long term’. What traditionally has been referred to as proper treatment has had only short term benefits to the patient. Traditionally, professionals in the industry treat the symptom. If you treat the symptom (pain or injury), yes you can get back in the game quickly. But the long term affects can be devastating and cut short any athlete’s career.
Recently, someone asked what I thought would have happened had Michael Jordan been drafted in Portland instead of Sam Bowie (whose career was hampered by chronic foot injuries)? The answer is who knows and who really cares.
The bigger question is what would we be saying about Michael Jordan if he had not recovered from injuries suffered to his feet early in his career. Three games into the 1985-86 season, Jordan went down with a broken bone in his left foot and was sidelined for 64 games before returning in mid-March.
The answer is that Air Jordan might have been reduced to a fraction of what he is today. According to his teammates and those who played against him, Michael Jordan (whom I first met in 1994) worked harder than any other player in the game on and off the court. In many ways, his work ethic overshadowed any treatments or training programs prescribed for him As a result, any trainer who worked with Jordan would have become a name in the industry because he was Michael Jordan. Had that same trainer worked with Sam Bowie, we have no idea how Bowie ‘s body would have responded. It is impossible to treat the two players with similar injuries with the same treatment because their body types and injury/training histories are different.
Oh by the way, many people forget or don’t know that Sam Bowie played in the NBA until 1995, he just didn’t play the way he was expected to based upon being drafted Number 1 overall ahead of the greatest player of all time.
Now back to Greg Oden so I can tie this all together. A proven surgical procedure undergone by hardworking Kobe Bryant (who works as hard as Jordan on his fitness level) to eliminate pain only fixes part of the problem: the pain goes away. That is a good thing because the pain prevented Greg from being able to workout efficiently. Additional benefits to the procedure Greg underwent earlier this year include reduced inflammation and possibly accelerated healing in the areas of his body affected by all of his surgical procedures. Based upon the sheer number of surgeries Greg has undergone, his body has probably built up a considerable amount of scar tissue and some nerve damage may have occurred as well. The procedure could potentially help with both. This is very positive for Greg’s comeback. But it is still not enough.
I hope Greg’s rehab and training program has focused on his weaknesses. As I’ve stated previously, Greg moves inefficiently because of weaknesses in his body that have caused injuries. Here are a few areas that were weak on Greg in 2008 and as evidenced by the repeated procedures in 2009, 2010, 2011, and 2012, possibly still affecting him today: glutes, hamstrings, quads, hip flexors, hip extensors, hip rotators (internal and external), peroneals, gastrocs, soleus, abs,anterior and posterior tibialis, and more–mostly on the right side. The left side indicated signs of significant fatigue and overuse. So Greg’s left side needed then and probably still does need a break, relaxation.
The Number One area Greg Oden needs to improve….his feet!!!
In particular, Greg needs to improve his right “foot flexion” strength. Can Greg grip things with his feet? As crazy as it may sound to the novice reader, it is a necessary part of efficient biomechanics and Kinesiology. As you’re reading this, take off your shoe and you’ll see what I mean. Place a towel flat on the floor and grip or pick it up with your foot (one foot at a time for 50 reps- hold each rep for 2 seconds). Try it and see how your foot feels. Some of you won’t make it to 25 before your foot cramps. If you’re right handed do the exercise with your right foot. Lefty’s just the opposite.
The feet are the single most neglected part of any training program. Less than one percent (1%) of all trainers or physical therapist include true foot exercises in the daily or even weekly training programs for their athletes. Now big manly types will say working out your feet is not important. Give them big strong massive biceps and they’ll take that guy. But let’s get real, we are seeing more injuries to knees, achilles, and other parts of the body related to weak feet.
We assume that because we are on our feet that they are functioning correctly, but that is not true. And no all of you you barefoot running enthusiasts, that is not enough either. Barefoot running only affects where the impact occurs not function of the feet. That’s a whole blog series I have set for October.
Here’s an indicator of whether or not you need to train your foot flexion or gripping: Do you wear flip flops? If so, you are overworking the top of your foot and ankle (dorsiflexion and toe extension). In my research for this post, I watched a youtube video promoting toe extension exercises for dancers. It is honestly the worst and most unnecessary exercise ever, unless you’ve suffered an injury that keeps you from wearing flip flops. Don’t get me wrong, some people will need it but 9 out of 10 would be negatively impacted by it.
Greg Oden and just about every other basketball player in the world needs the opposite. These athletes need to work on gripping things with their feet. Why do I say this? It’s because the shoes worn by basketball players prevents their foot and ankle from functioning properly. The solid rigid surface, the ankle taping…this prevents the ankle and foot from doing what it does naturally. So yes, Greg Oden has a weak right foot. In addition, he has a weak right lower leg complex: gastrocs/soleus.
This weak right foot contributes to his weak right lower leg, which contributes to his weaker right hamstrings, glutes, quadriceps, and other areas of his right leg. These weaknesses cause Greg to over use his left side which is what contributed to Greg Oden’s left patella injury in 2009. So if Greg Oden wants to come back in 2012-13, he’ll need to work hard, but he’ll also need to work on the right areas of his body. Most importantly, Greg should absolutely under no conditions perform the same number of sets and reps or stretches on his right side in comparison to his left. Greg’s injury history alone is an indicator that one side was damaged more than the other, so why do the same things on both? And yes, all of this was a part of the “controversial report” given to the Portland Trailblazers in 2008 and again in 2009 when contacted for a copy by Tom Penn. Emotionally, another major injury would probably end his career. I would hate to see this because I had a chance to have an impact on his career longevity.
I guess we can say that two chronically, injured players for one team might be playing in the NBA for other teams after being let go due to those alleged career ending injuries. And isn’t it amazing that one of them could win a championship (if he ends up in Miami and they win again). Shocking! I’m just saying… somebody other than me thinks these two guys are still worth it and can be fixed.
The bottom line is just because you read it on the internet or someone makes a statement about it does not mean that it’s true. Apparently one shoe has already dropped as Brandon Roy has signed with a new NBA team. Another shoe will drop when Greg Oden is signed before the start of the season and returns to the NBA. I’m pretty sure someone will sign Greg next season. And at worst, Greg can hang on for another 5 years or so going from team to team and make millions. I hope he works hard on the root cause of his injuries and not just the injury itself. Ask the question of your therapists, Greg. And make sure you get a real answer not just one to pacify you.
The only other question left for me to answer here is, “What’s my motivation?”
Well, it is truly to see Greg Oden and many other injured athletes back on the court or in the game. If Greg’s serious about a return, he should have a copy of his old report if he does not already have one. But also, he should get a new one. Oh and if he does call to request one, no one will never hear about it from me until long after he returned to the court. After all, you didn’t know about his previous tests as I kept that confidential not because I had to but because I wanted to keep it quiet. At anytime, I could have promoted my relationship with the Blazers or any athlete or team as many others in the field do. Having a famous clientele doesn’t make you an expert. Actually having a positive impact on them or sharing valuable information for their benefit is what makes me and others in the profession feel great about waking up every day to go to work.
Until Greg was let go, I was a background guy. That means when an athlete or team came to me, I stayed in the background. This is not about attention for me, it’s about bringing light to a dark situation. I want Greg Oden’s flame to shine. Let the candle burn Greg. Next week, I’ll detail Greg’s number 2-5 most important exercises to guarantee his long term health. Oh by the way, NBA teams, a guy with a tight back (back problems) can be fixed and is still worth a top draft pick. hint hint.
Zig Ziegler, The Sports Kinesiologist can be followed on Twitter @zigsports.
Around the turn of the century, a new buzzword began to circulate among experts in the fitness and sports industry–”Core” was the buzzword and a new revolution was born in sports and fitness training. Article after article appeared in journals and magazines touting the core as the area we need to focus on the most to lead healthier, “pain-free” lives. The media picked up on the buzzword. With so much exposure, just about every issue or injury from low back pain to poor sports performance, which we had previously attributed to other issues, were now believed to be miraculously cured by targeting the core.
In the 1990′s, the industry claimed low back pain was primarily affected by the hamstrings. Today, the industry and the media blame back pain and everything else on a weak core. This was and is 100% incorrect. Back pain can be caused by any one of hundreds functional issues. Experts in sports training, fitness, and even physical medicine (yes this includes highly respected doctors) also blamed many injuries and poor sports performances on poor core strength. With so much exposure and demand for improvement, every “fitness and medical expert” began creating exercises and programs targeting the core. The physical ailments and sports performances people seek to improve are also affected by many factors including learned behaviors or techniques which create imbalances (but that’s another post all to itself).
It is my belief that because the hundreds of thousands of professionals who work with people on their sports, fitness, and health goals placed too much emphasis on this one particular area of the body, we are now seeing the results of the failure of the industry to properly educate consumers on how to truly balance their bodies and lead a healthy lifestyle.
Many experts, and as a result, fitness seekers and athletes all around the world have over done it with “core training”. It was believed by some “so-called experts” that almost every problem in the body stemmed from weak core muscles. And according to those experts, if you could just strengthen your core all your problems would be solved and fitness goals attained.
Well… I call BS!. And over the next 1,000 words or so, I intend to explain why.
The “core muscles” and what it takes to train them has begun to cause an epidemic that needs to be undone. Why is it that while the industry has focused on the “core”, the number of people suffering from back pain around the world has increased. In addition, we have seen a rise in other “core related” injuries?
The “core muscles” have been incorrectly identified by the average person. In fact, I’ve searched the web, and most experts define the core as the abdominal and lower back muscles. Most people believe the core can be trained by performance exercises on a stability ball; adding resistance to abdominal exercises; and by performing numerous other activities we now call functional training. In truth, the core muscles are made up of all the muscles which meet in the center of the body’s planes.
In reality, the best way to define the “core muscles is “all muscles which affect the position of the pelvis”. This includes muscles originating and inserting at the pelvis and all of those muscles which affect pelvis position. This also includes some muscles of the lower body which are neglected when “training the core”. The pelvis moves in multiple directions and is essentially the first indicator of true stability (which is what we are trying to accomplish with “core training”). Now keep in mind, pelvis movements can be and are affected by movements of all the segments and muscles around it. This means, the core is affected by both feet, both legs, the spine, and the arms (because the arms are attached to the spine via the trunk).
The ideal pelvis forward tilt is 7 and 10 degrees in men and women. some experts would say that a desirable forward pelvic tilt is 0-5 degrees in men and 7-10 degrees in women. Those are desired averages, but we are not striving for average, we should be working towards ideal. Based upon my research of thousands of people from all walks of life, the actual average is greater than 17-20 degrees of forward pelvic tilt. This is more than twice the ideal. And the majority of participants in my research are athletes who supposedly have the best fitness levels and training.
While I do want to make it clear that training the core is important, I want to clarify that “core muscles” previously targeted through isolation and functional training are no less important than any other muscle in our body. In fact, what has happened as a result of the over emphasis on the core muscles is the following:
1) Any muscle when focused on as the muscle group to target can be OVER-trained and as a result, OVER developed.
2) Any muscle group when targeted can be exercised improperly, negating any real benefits that would have been gained had the exercises been
3) Compensation injuries can occur as a result of over-training or over emphasizing any muscle group.
In truth the core is the center of the body where forces cross the mid-point of the body splitting the into multiple planes.
For simplicity, the body is split into halves from upper body to lower body (Transverse plane); Front side to back side (Coronal Plane); and left side to right side (Sagittal plane). In order for the body to become balanced, exercises must target all areas of the planes in some cases through multi-planar exercises (Functional and rotational movements in all directions).
One aspect of multi-planar training that is rarely taken into consideration is the fact that in an effort to seek balance, those planes are affected by work that is done diagonally from left to right and right to left, from upper body to lower body. What does that mean? The body is divided into the three (but really four) planes. However, the left arm does its job in conjunction with the right leg. The right arm, works with the left leg. So the new, “X-Plane” has to be trained as well.
A muscle is over trained and over developed when it is targeted more than its opposing muscle group (in all planes). If I only work on my right bicep and not my left, its obvious that my right arm would be stronger, more dense, and heavier than my left when doing activities that require both arms. If we spend time isolating the low back and abdominal (which the average person defines as the core), we end up with abs/low back that are significantly stronger than our feet, lower leg muscles, glutes, hamstrings, possibly even quads.
As a result, instead of strengthening the body’s ability to transfer energy and have support from the “core” to perform functional movements, we are actually weakening, the core and its ability to perform true functional movements. What is an indicator that the core has been over-trained or improperly trained? That’s the easy part. We will see people suffer more injuries to hamstrings, the groin, chronic low back pain, and a the presence of a severely forward tilted pelvis (anterior pelvic tilt).
This negative pelvis posture can lead to an increase in ACL/meniscus knee injuries, plantar fascia injuries, patella tendonitis, groin pulls, hamstring strains, shoulder injuries, low back/spine injuries and pain, abdominal strains, neck pain/discomfort leading to surgeries of the cervical spine, and hundreds of other physical issues.
So let’s stop isolating the core and begin to work on developing balance in the body, in all planes, not just at the “core”. Fitness should be achieved by working to develop the entire body…From the Ground Up!
In future writings, I will address some key exercises, which if done properly will provide more true benefit to the “core” than the road the industry is currently taking to a healthy core.
Follow Zig Ziegler, the Sports Kinesiologist on Twitter @zigsports. Zig is the author of he soon to be released book, Absolute Kinetix: Fitness From the Ground Up.
To keep up with the latest from Zig Ziegler, follow Zig on twitter @zig_ziegler.
While Derrick Rose was tearing his ACL, I spent the morning conducting a 3D-Biomechanics Assessment on future projected Top Five NBA draft pick Shabazz Muhammad. While there are no guarantees the UCLA bound senior at Las Vegas’s Bishop Gorman High School will escape future knee injuries, the move will provide Muhammad with exercises targeting any weaknesses or imbalances in his body. The results are in the hands of Muhammad along with his current and future trainers at UCLA.
I appreciate the your coming out to do the tests on me,” said Shabazz. “I will do what I can to improve.” In addition, to the biomechanics assessment to identify his risk of injury, Shabazz, also was able to benefit from a fine tuning of his pelvis position during shooting free throws. Already with a free throw shooting percentage around 85%, after the adjustment to his pelvis, Shabazz stated, “I already feel myself shooting straighter.”
The subtle techniques changes will become permanent as Shabazz follows the strength and conditioning exercises and stretches recommended specifically for his body. But most importantly, Shabazz and other young players can significantly reduce the risk of overuse and compensatory injuries related to muscle imbalances.
For Derrick Rose, it’s not too late to help improve his ability to recover from his recent ACL tear. His recent injuries (prior to the ACL tear) were warning signs that something was about to go dreadfully wrong. It’s like ignoring the check engine or oil light in the car. Sure we can keep driving; check the oil and probably notice that we are low on oil (adding more), but eventually the symptom turns into a major problem. The light was an indicator that maybe we had an oil leak? I’m just guessing here but I’ve seen enough simple symptoms turn into major problems.
A tear to the anterior cruciate ligament (ACL) in the knee usually occurs in one of two ways: 1) hyperextension of the knee 2) rotation of the knee. Both causes contribute to ACL tears while bearing more weight on the knee than supporting muscles can bear. If either motion is too great, an ACL tear or meniscus tear (at a minimum) can occur. This type of non-contact injury usually occurs while the athlete is attempting to change directions. (There are other ways for injuries to occur but these are the two most common methods for non-contact related ACL/Meniscus tears).
Rose suffered a torn ACL while landing and attempting to RE-accelerate or change directions during his trademark “jump stop” power move. In my opinion, the injury occurred during the transition phase of the move where Rose was in between stopping and starting (changing directions). At the point in the game when the injury occurred, Rose’s body (which had spent the past two months compensating for injuries below the knee) was experiencing in-game fatigue. His ACL tear could have happened in the first minute or the last minute, however, because of his history.
Rose is and has always been a player who relies on his explosive leaping ability, quickness, and all around athletic ability. He has been labeled a fearless player who plays with reckless abandon. That all changed with a little over one minute to play in game one of the 2012 playoffs against the Philadelphia 76ers.
How will this affect Rose going forward?
In the future, when Rose moves to his right, he will be able to play aggressively. However, stopping or changing directions while moving to the right will be extremely challenging. As Rose attempts to change directions while moving to the right, the inside of the left knee must assist in deceleration. If the left leg does not absorb its appropriate share of the workload during this deceleration, one of two things is bound to happen: 1) re-injury to the left knee or 2) new injury to the right knee.
As Rose attempts to move to the left, the outside of the left knee absorbs the majority of the workload while moving in that direction. This creates less of a challenge for Rose in the future because of the nature of the injury. Stopping or changing directions for Rose when moving left should be considerably easier for Rose to do as the inside of his right knee will bear the majority of the load in deceleration. The act of actually pushing off is primarily the responsibility of the outside of his left leg. As a result, Rose will be able to change directions when moving left, but may subconsciously rely more on his right leg.
In my description above, Rose will be forced to overuse his right leg considerably, resulting in a higher risk of injury to the right leg from foot to hip. We may see Rose tear his right ACL or retear his left, develop Patella tendonitis in the right knee, or suffer an injury to the right hip,or foot (which was supported by muscles already weaker than those in his left leg).
The biggest concern for Rose is the fact that Rose’s injury is an injury related to rotational stability of his left knee. The ACL attaches to the inside of the lateral aspect of his femur (thigh bone) and the lateral aspect of the medial portion of the tibia (lower leg). In stabilizing the knee, the ACL resists rotation. In Rose’s case, his lower leg internally rotated and could not stabilize before his femur began to externally rotate. The rotated out of sequence and in opposite directions.
The most neglected part of ACL surgery and rehab is the rotational stability of the knee. During surgery, the bones of the upper and lower leg are not typically rotated back into their normal position prior to the injury. The new ACL is attached typically with the two segments in the posture they moved to when the injury occurred.
As for rehab, we constantly hear “experts” in the field of medicine and rehab referring to the quadriceps and hamstring muscles as the most important to ACL recovery. But we are rehabbing only part of the knee’s stabilizing muscle groups.
Why is it that no one discusses the extremely important segment of the body below the knee with muscles that cross the knee and assist in the stability of the knee? It’s because the protocols have become watered down and we only look at the primary muscles that flex or extend the knee. Apparently, experts in the field of rehab and medicine have forgotten that the lower leg muscles assist in stabilizing and supporting healthy knee function. Yes, I’m referring the entire muscle group of the lower leg.
The Gastrocnemius/Soleus complex (typically referred to as the calf muscles) is the single most important muscle group to target when recovering from ACL surgery, the quads and hamstrings are important but no more important than the lower leg muscle group. Yet, only a minimal portion rehab is dedicated to targeting the lower leg. The Anterior and Posterior Tibialis, and mobility of the peroneals are extremely important to complete recovery.
In addressing this area to aid in recovery, Rose’s therapist must pay attention to the rotation of the knee, by manually assisting the repositioning the tibia/femur posture. In doing so, they can return his knee to its pre-injury “joint posture”. If this happens, Rose can return quickly and achieve near pre-injury levels, reducing his risk of re-occurrence.
If you ask anyone who has ever undergone ACL or meniscus rehab (Greg Oden, Brandon Roy, Terrell Owens, myself (8 times), and the list goes on and on) no one will say that they spent a good deal of rehab time working on developing the lower leg muscles. For Derrick Rose and others to recover completely from ACL or other knee injuries, more emphasis must be placed on the lower leg. If not, Rose will become an out of control player (unable to stop to change directions) or suffer repeated injuries to his knees and be out of the game before he’s 26 years old. Keep in mind that rehab type exercises for Rose will need to become a part of his regular training program to ensure that his “fixes” are permanent and to keep him from suffering chronic knee, hip, foot, and other injuries. As a Bulls fan, I’m pulling hard for Derrick Rose, but I have my concerns.
As a Sports Kinesiologist specializing in human movement, I’m pulling for experts in our field to open their eyes and close their protocols. Address every athlete individually, not the injury. The injury is just a symptom that something went wrong. And in the case of Derrick Rose, Greg Oden, Brandon Roy and others, something went wrong repeatedly and will continue to do so, unless the root cause of the injury is address. Let’s hope Shabazz Muhammad and other young players bound for the NBA can benefit from the changes in the sports, fitness, and medical injury early enough to stop the trend in accepting injuries as part of the game. Many injuries can be prevented but we have to take steps to make this a reality.
Zig Ziegler, The Sports Kinesiologist, provides feedback on injuries to A-List athletes in an effort to help educate athletes and parents on the prevention of injuries. Be sure to check out other stories here about Greg Oden, Brandon Roy, Mark Sanchez, Tiger Woods, and more. Follow Zig on twitter @zig_ziegler.