A RESPONSE to KNEE INJURY PREVENTION STUDY

"Some training methods are better than others at preventing knee ligament injuries in young women", wrote Ms. Madeline Kennedy on behalf of Reuters News Agency, quoting advice given by researchers.

Ms. Kennedy's column focussed mostly on recently completed research by Dai Sugimoto of The Micheli Centre for Sports Injury Prevention in Massachusetts. Mr. Sugimoto's conclusions were that: “We know neuromuscular training can reduce ACL injury in female athletes, but we were not sure what exercises are the best to attain the maximal prophylactic effects”. Really?

PREVENTATIVE MEASURES.

The word, "PROPHYLACTIC", comes from the Greek for "an advance guard," an apt term for a measure taken to fend off a disease, pregnancy or other unwanted consequences, like tearing your ACL due to weakness or instability, for example. My word for it is PREHAB.

While it's clear that exercise is key, I keep being drawn back to the part of Sugimoto's statement that read: "but we were not sure what exercises are the best to attain the maximal prophylactic effects”. Dr. Eric Goodman, creator of Foundation Training, and other like-minded teachers of movement would smile broadly upon reading that. Goodman's aptly named "FOUNDATION TRAINING" is one of the simplest, yet effective training methods I know of for both its neuromuscular and prophylactic effectiveness.

According to Ms. Kennedy's article, Mr. Sugimoto and his researchers "analyzed 14 studies of exercise intervention programs, looking specifically at four different exercise approaches, including balance, jump training, abdomen-stabilizing exercises and strengthening of the legs and hips". While many are now moving towards the understanding that movement is key to health, there is still a tendency to revert to outdated modes of isolation training to resolve all issues.

Sugimoto knew enough that exercises that helped in the prevention of ACL damage were those that built "strength in the back of the legs and in the hips. That was also true of programs that focused on strengthening and developing more control of the abdomen". Perfect! What he wants us to do is a "FOUNDER" - one of the most important exercises that we must learn when practicing the aforementioned, Eric Goodman's "FOUNDATION TRAINING" movement modality.

I see a flaw in the exercises recommended by Sugimoto where he presumes, I suppose, that each individual is even in a position (or aptly: can position themselves correctly) to perform these exercises. No, not everyone can.

Unfortunately, this is still a widespread flaw in most exercise recommendations. The pro-forma thinking goes: Client wants to have great glutes. Squats work your glutes. Let's do squats.

The flaw is that this process needs to be reversed. Our glutes are NEEDED to do squats, along with other muscles around the hips, knees, ankles and spine so that we can be stable while squatting. Loading up an Olympic bar is not where we should start. Learning how to load our joints should be.

I wrote previously that just because you call an exercise "THE SQUAT" does not mean that we are practicing squatting. We develop muscles to serve a function, which changes the way they look as they adapt to the work we ask of them. This is why injuries are piling up in movement modalities ranging from Yoga to CrossFit - we should be training to develop movement skills. And, the MILITARIZATION of FITNESS isn't helping matters.

Let me offer a few recommendations that build upon the advice given by researchers in the Madeline Kennedy article, and how we can use the practice of Foundation Training in the prevention of injuries:

  1. "Training programs that aimed to build strength in the back of the legs and in the hips significantly reduced the number of ACL injuries when compared with programs that did not. That was also true of programs that focused on strengthening and developing more control of the abdomen". Let's think more globally: Training programs should aim to build strength in the entire posterior chain and developing more control of our spine so that we can move more stably through the hips.
  2. Programs that included more than one type of exercise were significantly more effective than those using only one type. “Neuromuscular training has to incorporate many exercise modes,” Sugimoto said. “Performing only one exercise mode seems ineffective.” Let's think more globally: Any exercise program that focusses on isolation movements exclusively is less effective than those that emphasize muscle chain interaction.
  3. The researchers note that while balance and jumping exercises were somewhat helpful in reducing injury, they were not effective unless combined with other exercises. Let's think more globally: Any exercise program that does not firstly encourage joint loading and stabilization is less effective than one that does.

Ms. Kennedy's article can be found on reuters.com or search for title: "Review finds best exercises to prevent women’s knee injury".

This posting was an original contribution to the good folks at Foundation Training - February, 2015

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