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.

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A child playfully squatting without fear of damage to knees and squatting perfectly through the body’s full range of motion without regard to injury to the knees or back.

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.

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Arnold Schwarzenegger squats in the gym with a 2×4 under his heels. This action forces the weight into the forefoot forcing increase gastroc/soleus/hamstring/glute contraction when standing from the squat position. This also disables internal tibia rotation (lower leg rotation), while enabling external rotation of the thigh at the hip. (While his base is narrow contributing to overload of the hip joint (scientifically referred to as the acetabulofemoral). However, there are no glute medius issues present here.)

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.

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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.

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Perform a calf raise by elevating your heels and pressing through the front of your foot. increase the intensity in your glutes by turning your feet and legs outward a few degrees.

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.zig hurdle

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

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Working with Pro Athletes is Not Enough to Make You an Expert; Yet Another Surgery for Brandon Roy!

Was his career really over? With chronic knee pain and seven surgeries later, Brandon Roy is still fighting for his playing career. (Wire image)

To keep up with the latest from Zig Ziegler, follow Zig on twitter @zig_ziegler.

Brandon Roy was once regarded as one of the most prolific guards in the NBA.  With excellent lateral explosiveness and sleek moves to the basket, the All-Star guard was poised to go down as one of the greatest in NBA history.  Just before the start of the 2011 NBA season, Brandon Roy announced his retirement from playing professional basketball.

Unfortunately, Brandon Roy has been a victim of the system. The system is present in basketball, football, and baseball, and all sports at the professional and youth levels. The system is a part of a culture that we have seen all to often shorten or ruin the careers of some of sports greatest athletes.  Many athletes go on to to achieve success in spite of this system and culture.

The system and culture I am referring to is related to the treatment and care of athletes, and most importantly in Brandon’s case, care of sports or athletic injuries.  In the world of sports, injured athletes are viewed as unable to help the team and often times a distraction.  Many coaches, knowingly and unknowingly, relegate the mental state of injured players to the bottom of the depth chart as well as their bodies once an athlete is injured.  Some athletes are so dedicated to their return that they will push themselves hard to get back on the court or the field even when their bodies show signs that they are not ready.  Brandon Roy is one of those athletes who will do whatever it takes to get back on the court.

Beset with chronic injuries to his left knee, Brandon wore one knee brace or sleeve while playing in Portland. (Getty images)

Some successful athletes seek advice outside of their immediate medical team. After seven surgical procedures, Brandon Roy did just that and all I can say is… Good for Brandon!  Public perception is that if a medical group, team of doctors, physical therapists, athletic trainer works with a professional sports team they must be the best. If a pro team trust multimillion dollar athletes with a medical expert, the average person believes that medical group must be good enough for them.  Unfortunately, that’s just not true.  In today’s world, some professional teams hire based on cost.  Others hire or obtain a team based upon a close personal relationship. The buddy system is always at play especially in America.

In 1994, I sat in one of my graduate school classes at the University of Northern Colorado wondering what was the next step I would take towards achieving my goals.  After a few weeks of contemplating my future I sat down with my grad school adviser, Dr. David Stotlar. A well respected administrator around the country in sports, Dr. Stotlar served as one of the pioneers in the emerging field of Sports Marketing. The UNC program was one of only five universities in the country at the time offering a Master’s degree in the field of Sports Marketing and Administration.  I asked the following question:

What happens in the interview process for a job with a professional sports team after I complete my master’s, if I am down to one of the final two candidates for a job? There I would sit with a Master’s Degree in Sports Business, a Degree in Kinesiology, and experience as a former athlete.  Candidate number two, happens to be the workout or drinking buddy of the General Manager’s son and also plays golf periodically with the decision maker.  I asked, “Who would get the job?”  Dr. Stotlar replied, “Well Zig, unfortunately for you, the job is likely to go to the buddy of the GM’s son. ”

At that point I set out to work on relationships and building a reputation of doing quality work. My efforts lead to friendships with numerous professional athletes including Charles Barkley, Michael Jordan and many others.  i worked hard to open the doors to numerous opportunities in professional sports. I’ve been blessed to have been able to work with some of the greatest athletes in the world.  But that alone does not make even me anymore of an expert than the recent college graduate. What makes any person better in their field and in life is their experiences and how they learn from them.  Working with some of the greatest athletes in the world in multiple sports has forced me to think outside of the box and evaluate each athlete and their goals or conditions on an individual basis, regardless of whether or not they played the same sport or suffered the same injuries as others with who I had worked.

All too often that happens today, especially in professional sports. After all, just take a simple look at how often coaches are recycled from team to team.  NBA coaches move from one team to another. When a head coach gets a new job, he brings in his entire staff of good friends, brothers, and associates whom they trust.  A coach can bring in their entire system to their new team.  Assistant coaches, strength coaches, even athletic trainers sometimes change jobs based on the buddy system  Once in the system, the less effective at their jobs begin to work the system to ensure their longetivity in the event the coach who brought them in moves on.  If a staff has been there for a while even through poor job performance something else is keeping them on staff. Most of the time, that something is relationships.

The bad news is for the new team is that If a coach’s entire system didn’t work in one program, its not likely to work in another  The smart members of that new staff recognize the writing on the wall from the last job and start working relationships the moment they walk in the door.  The culture of professional basketball is unlike any other professional sport.  In football, coaches bring in experts and specialists on offense and pair them with experts on defense and other areas crucial to the entire team’s success.  In basketball, an offensive guru, often gets a job and fills crucial coaching roster spots with more offensive gurus to help implement their system. Professional sports team positions are filled with coaches and administrators who were fired as a group from one place and move as a group to coach a whole new team.  Coach’s mistakenly bring all the problems they had in one organization over to their new teams. Why do they do this?  Loyalty, comfort, and control.

Professional sports are highly political and and a close fraternity. Once you are in, you could be in for life. Even if you are not the best in your field. Once you are out of the system you may be out temporarily or permanently depending upon your persistence and actual value to a team or player.  You can be kicked out of the fraternity sometimes based on the simple fact that you challenged the system, even if you are one of the best at what you do. This is the buddy system at its finest.  Unfortunately, this buddy system isn’t just happening with coaches on the bench, it happens with experts who care for the athletes.

And that is not the best way to determine the best care for multimillion dollar athletes.

Sometimes a handshake is all it takes to become a part of any professional or collegiate sports medicine or strenght and conditioning teams. Others pay for the rights (sponsorships) or accept less pay for treating players. Any money not paid for services is made up by the publicity from the association with a professional team.

It’s definitely not the best way to provide care for youth athletes. This buddy system affects youth sports too, as parents race their kids to the lines building in the offices of the team doctors for professional and collegiate sports teams in their area.  Often, you hear parents boast about getting their kid in to the see the team doctor for XXXX professional or collegiate teams.

Often times, they boast right after their 14 year old has completed an unnecessary surgical procedure when all they might have needed was rest and proper body development.  they won’t even know this procedure was unnecessary for years to come.  This trickle down affect is causing many youth athletes to now begin to suffer repeat injuries. This system is broken and won’t be fixed until athletes take control of their own medical care.

An athlete with repeat injuries is often labeled negatively as injury prone or high risk.  Once an athlete is labeled as have high risk of injury or injury prone, they can be blackballed or see their career placed in jeopardy as a result of what has nothing to do with them as a person.  Injuries to a player like Brandon Roy are not treated them same. And this credit can be given solely to Brandon himself.  He is given the benefit of the doubt and ample consideration because of his talent and excellent character.  Brandon Roy is a great person.  As a result of his character and personality, people root for him.  I root for Brandon Roy, Greg Oden, Derrick Rose, and even Kobe Bryant (I’m a Bull’s fan remember) especially when it comes to their health. Every player deserve a better healthcare system.  A system where they can have open access to the best health care available and believe or not, they currently do not.  Some programs obviously get better care than others as they hire medical staffs that are on the cutting edge or at least open minded.  Brandon Roy deserves a chance to get healthy and stay healthy.

Less than a year ago, Brandon Roy was headed for retirement and probably a career in coaching basketball.  After what I am sure was careful consideration and weighing his options, Brandon took the steps he believed necessary to get back on the court.  It is reported that Brandon underwent PRP (platelet rich plasma) injections similar to those reportedly undergone by Kobe Bryant, Greg Oden and others in an effort to help aid in the recovery and repair of damaged or deficient tissue.

I can imagine Brandon felt great in the days and weeks following the procedure.  As a result of how good he felt and a testament to his own personal work ethic, Brandon Roy was able to return to the NBA after many had given his career up for dead.  Brandon Roy proved many doubters wrong.  I for one was excited about his comeback.  After all,  one of my earlier writings predicted that Brandon Roy could and would play again!

Unfortunately for Brandon, his road to recovery is not quite complete. I was not surprised when I awoke on November 19 to reports that Brandon Roy would undergo an arthroscopic procedure on his knee.  After seven procedures on his left knee, this surgery was to Brandon’s right knee.  This is concerning to me and should be to his medical team in Minnesota as Brandon has now started to experience “compensatory pain and injury to what has previously been a healthy body part.  (Remember Greg Oden in 2008/2009: Oden Rupture Patella Tendon in healthy left knee as a result of compensating for multiple previous surgeries on his right knee. Oden first began to experience signs of patella tendonitis in the left knee months prior to the left knee injury.  In my opinion, someone addressed the patella tendonitis as a symptom, not a compensation injury).

In Minnesota Brnadon Roy can be seen wearing two compession sleeves knees sleeves. This can be done as a result injury or pain to both knees or as a preventative measure. (Getty Images)

A compensation injury occurs when either consciously or subconsciously a person unloads a previously injured area to avoid pain, discomfort, or re-injury.  Typically, an athlete who suffers an injury to the left knee shifts that stress to the other leg. (This involves repeated injuries in the case of Brandon Roy)  Think about this, when an injury occurs the first response from the brain is to protect the area from further pain or injury. This can be notice by the athele who injures one leg and hops off the field or court on the other leg. The athlete is so focused on being in control of their body and showing that they aren’t helpless that they use one leg instead of two to go from point A to point B.  Crowds often applaud this effort. But in reality it can be seen as a foreshadowing of things to come.

While surgery is a way doctors help repair specific damage, surgery can still be considered an intentional injury to some tissue in an effort to repair a more important injury.  Immediately after surgery, an athlete is unable to utilized the newly repaired leg for some limited amount of time.

What’s next for Brandon?  Well unfortunately I predict another injury to Brandon’s left knee immediately following this surgery. Brandon’s healthy right knee has now forced all the stress back to his chronically injured left knee and upon return to the court if not before, Brandon will begin to experience more pain and discomfort in his left knee.  If he shifts that stress immediately back to his right knee, Brandon could suffer cartilage damage, an MCL (medial collateral ligament) tear, or an ACL (anterior cruciate ligament ) tear or Patella tendon issues on the right knee.  Because of Brandon’s history I would put my money on the right knee suffering a more acute injury but he may begin to experience more pain on his left knee before he even gets a chance to get back on he court.

Compensation injuries are difficult to deal with and become chronic injuries almost instantly unless the root cause of the problem has been address. A word of advice to Brandon:

  1. Eliminate surgery as an option unless there is structural damage.
  2. Identify the root cause of your issues and stop settling for the quick fix.
  3. Hire someone who can pay attention to detail of how you perform each exercise during rehab and strength training.

I have no personal desire to hold Brandon’s hand through recovery from this or any surgery. But will readily offer my advice to him and his staff on what is contributing to his injuries. I require a lot from any athlete I work with emotionally and psychologically but most importantly, I require support from the people around the athlete.  They are the ones who are with the athlete every day and should be able to see impending issues.  Until Brandon stops experimenting with procedures, surgeries and other quick fixes, his injuries are destined to repeat themselves of migrate to other parts of his body.  Brandon Roy can get back on the court and stay on the court but he has to select better people to help him achieve his goal.

If there is one thing the last year has taught me personally, it’s that your career can be affected by the people you put around you and the decisions they make.  My professional and personal life was affected by the actions of others whom I brought onto my team almost five years ago.  I accept that responsibility that I allowed them to turn me into a victim. But no one can be a victim forever. Brandon Roy’s life is currently being affected by people on his team who may not have intentions of harming him but they are doing just that. Brandon has become a victim allowing just about anything that might help his injury recovery to drive his thoughts and procedures.  Get to the root cause of your injuries Brandon. Take control back Brandon! It’s not easy, but I did it and so can you!

Zig Ziegler is a sports kinesiologist and professional sports consultant.  To keep up with the latest from Zig Ziegler, follow Zig on twitter @zig_ziegler.

Derrick Rose Update: Career in Jeopardy…Why Rose will never be the same!

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.

As for Rose, Oden, and others, to help us all understand the risks of rehab and recovery, let’s first gain a better understanding of the injury itself.

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.

Derrick Rose: Career in Jeopardy! Why he may never be the same.

To keep up with the latest from Zig Ziegler, follow Zig on twitter @zig_ziegler.

In this day and age of high flying, fast moving, power displaying NBA players, Derrick Rose was regarded as one of the best! MVP in 2010-11 season; comparisons to Michael Jordan; and numerous championships already planned for Chicago in the minds of fans like me.  The dream of Chicago Bulls fans around the world has now come to a knee buckling jump stop. Hoping for the best for you D. Rose, but I have major concerns. So here we go…

Derrick Rose tore his ACL (anterior cruciate ligament) and MCL (medial collateral ligament) while performing his signature power move: Jump Stop and attack or pass.  Since his rookie season in the NBA, Rose has amazed fans around the world with his athletic ability, conjuring up images of and comparisons to the greatest of all time, Michael Jordan who led the bulls to six (6) NBA championships (All of us Bulls fans know there would have been more banners if not for baseball).

While watching the video, you’ll notice Rose’s body was off balance (if you look closely) as he landed with more weight on his left leg than his right leg. This is a move that is partially learned (NBA players often practice the move landing on the inside leg incorrectly) and in other cases it is done subconsciously, as a compensation for weakness or injury to the other leg. Weight should be more evenly distributed with more weight on the outside leg to actually change directions more effectively.

While moving to his right, Rose should have been preparing his body to land with slightly more weight on his right leg than his left.  To help you understand, when moving to the right, it is the right leg’s job to stop the lateral movement to the right. The left leg acts as a decelerator with weight distribution (40-45% left, 60-55% right). In Rose’s case, his left leg (in hitting the ground with more of Rose bodyweight on it) attempted to stop his motion to the right, with limited weight absorbed on his right leg (based upon an evaluation of Rose’s posture in video footage of the incident).

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In my opinion, Rose was most likely compensating (as many great athletes would do) for the foot injury/soreness he felt less than two weeks ago. Now Rose has been battling injuries all year:

According to Fox Sports these are the injuries reported since January 11, 2012:

1/11/2012 Sprained left big toe. (Catalyst to right leg injuries)

1/16/2012 Sprained left big toe.

2/10/2012 Strained lower back

3/14/2012 Groin

4/10/2012 Sprained Right Ankle (Key injury leading contributor to ACL/MCL tear)

4/16/2012 Soreness Right Foot (Key injury major contributor to ACL/MCL tear)

Other injuries Rose suffered during his brief career include additional injuries to his right ankle and a bruise to his right hip from a collision with Dwight Howard in 2010.

Rose’s injury patterns indicate a clear cut case of compensating injuries shifting back and forth from his right side to his left, and from his feet/a

nkles up to his knees (with the exception of ankle sprains and contact related injuries).  It is blatantly obvious to anyone who understands how the body works that Rose’ left leg should have been experiencing a significant amount of left leg fatigue as a result of the recent right foot and ankle injuries, regardless of what caused them.

In my opinion, this injury would have happened anytime.  And unless Rose and his medical team address the root mean cause of his previou

s

injurie

s and compensations related to them, the ACL injury could not have been prevented.

Now, one thing to keep in mind is that some of Rose’s injuries occur because he plays fearlessly with reckless abandon.  It is that style of play that now w

ith an ACL and MCL injury could lead to more injuries from Rose. In addition to the risk of more injuries (next up is

either a reoccurrence of the left ACL tear or a tear of the right ACL within 12 to 18 months (which is actually pretty common).

I’m thinking a tear of his right ACL happens first but this one is tough to predict because of Rose’s style of play. If I were to complete a 3D Motion Analysis of Rose’s body, I’d be able to provide a more accurate prediction (This is based solely on my opinion and evaluation of his injury history and playing style).

Rose ACL tear is clearly related to his recent injuries.  Many people are asking should Coach Tom Thibodeau have taken Rose out of the game.

Actually, coach has no idea about limits that should have been placed on Rose after his recent string of injuries. However, common sense would tell any medical professional that Rose’s play should have been limited (bring up images of Brandon Roy against Phoenix in 2009 playoffs).

It’s easy to see that Rose was compensating for the soreness in his right foot. This can be done consciously or subconsciously. Only Rose really know

s how

his foot feels when he jumps, changes directions, or lands on it. If Rose was feeling any fatigue at all in his foot, it was up to him to salvage his career. However, because no player wants to be considered soft and take himself out of the game, Rose chose to stay in the game (as would every other athlete who is taught “no pain, no gain”) hopefully sending a message to the Philadelphia 76ers.

Please keep in mind it is the medical staff whose job it is to impose limitations on players’ time on the court or in a game when a player returns from

injury.  It is not the responsibility of the coaches at the professional or any level to determine if a player is physically recovered.  Thibodeau’s job is to play the players who are eligible to play, not monitor rehab and fitness levels of players. So let’s give Thibodeau a break. If the injury hadn’t happened, and the Bulls won by 20 with rose on the court, this topic related to the injury would be a non-issue.

When Rose comes back after surgery, his style of play will definitely change. We won’t see the old powerful, explosive Derrick Rose for 2? 3? Ma

ybe 4 years, and that’s only if there are no setbacks over the first year.  His signature “jump stop” power move could be what ends the career of another bright young NBA star.  Keep in mind, an ACL injury is not like a meniscus/cartilage injury.  It can be death to an athlete who relies on explosiveness and changing directions. The ACL and MCL provide stability to the knee, while cartilage essentially acts as a cushion.  Rose needs stability of the knee for his game to be effective. It will be at least one year before Rose’s repaired ACL is healed enough to provide the stability for the types of moves Rose needs to make when playing.  And let’s also not forget about those chronic injuries on his right side.  They could at any time cause an injury to his right knee or re-injury to his left.

Yes. Derrick Rose will play again but it is highly unlikely he be the same high flying Derrick Rose we knew before the fourth quarter was near its end this past Saturday. I’m praying for a safe surgery and really, really, good rehab. And hey Derrick in case you’re listening, objective measurements of how your body is functioning during rehab and identifications of your injury related compensations will be the key to your return to the Derrick Rose glory days. Speaking as a Bulls fan sin

ce the arrival my home states’ Scottie Pippen, I’m pulling for D. Rose.

While I have not worked with Derrick Rose, I write this post at the request of several readers who have posted or emailed with questions about the topic.  My preference is to comment on athletes based on objective information.  This post is merely my opinion based upon a subjective review of Rose’s injury history and video of the actual incident in which Rose tore his ACL.

On Wednesday, I’ll discuss ACL injuries, the surgical procedures and the most common aspect related to the surgery and rehab that could be considered negligent in the areas of orthopedic surgery and rehab.  In this story, I’ll explain why I feel Derrick Rose’ career could be over and what Rose and his therapists and trainers can do to help extend his career and reduce the risk of repeat or compensation injuries related to the ACL/MCL reconstruction he is about to undergo.

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, Mark Sanchez, Tiger Woods, and more.  Follow on twitter @zig_ziegler