Parent's Field Guide to Spotting Trouble (and possible injury)

As a parent, my number one job at all times is to make sure my children are safe. Period. 

When they’re young, what we’re looking for as parents is a piece of cake: things like shouting “Look both ways!” as they get ready to cross the street. Or, “have you washed your hands?” before dinner. But, as our children turn into young adults with their physical abilities developing at lightning speed, it can become less obvious to know what to do, say, or ask when you sense *something’s* not right.

At the youth levels (under age 15, especially), coaches are almost always under supported, so waiting on the coach or a member of the medical staff (ha, the team doesn’t have that - you’re it!) to make the call or assessment is likely inefficient.

Get Certified!

Before I dive into my tips, please be sure to take the time to take and/or maintain a current CPR/First Aid course. This is a crucial step helping to identify and respond to emergencies. Having as many people around sporting competitions who are trained in these areas is extremely important and falls under the “it takes a village” category.

Let’s Get to It

Alright, to help with spotting signs of trouble early, below is a field guide of sorts based on the information I’ve gathered over the years. Injury and potential for injury is something that I’ve spent countless hours and many years cataloging as I watched thousands of practices and competitions.

Here’s the thing I want to get across: I’ve learned to greatly appreciate how important it is to put the health of the athlete’s body over all else. As a parent, I’m sure you agree and want you to know that you can and should help.

You may read some of my below recommendations and think: there’s no way my kid is going to get taken out of practice simply because of X, Y, or Z. But, if the consequence of NOT taking action is life altering pain or surgery, would it be worth it?

Here are five things to look out for:

1. Trust your gut. No one knows how your child moves, feels, and responds to questions better than you. If something feels off, you should investigate further.

2. Discuss the realities of injury with your child at a time outside of practice/competition. Explain that your main goal is to keep them safe/healthy and if you notice something you want to know more about that you may pull them aside to find out more. Setting expectations ahead of time can go a long way “in the moment” when they don’t want to answer your questions.

3. Watch locomotor patterns: this is a big one! If your child’s gait becomes visibly abnormal and doesn’t smooth back out after a few minutes, you will need to find out what’s going on. A stride with a visible limp or another compensatory pattern of some kind (leaning to one side, for example) must be addressed.

   1. Possible causes to consider: previous injury, strained muscle(s), stress fracture, growth, stress reaction

      1. If your child is coming back from muscle strain or another known injury, just a brief check in to find out how they’re doing and then reverting to the action plan, as needed

      2. If there is no known injury, ask questions and use your best judgement.

   2. If your child is able to normalize their gait within a few minutes, make a mental note and follow-up afterwards.

4. Repeatedly grabbing a body part after movement: you usually see athletes do this who are working through some kind of discomfort (ex, pitchers and their shoulders or elbows). Use this as a trigger to ask questions.

   1. It is worthwhile to find out where the discomfort is coming from: joint, muscle, or something internal? As this will give you insight on any subsequent actions that need to be taken.

   2. Young athletes will often give a response indicating they’re “working it out” or “a little tight”. From experience, I can tell you that something at least slightly more significant is underlying those answers. Root causes often harken back to a strength deficit and/or overuse.

5. Head impact: this could be a fall to the ground or an impact with another player or object. Head injury should be taken very seriously and always err on the side of caution. If your child was knocked unconscious, seems disoriented, or vomits as a result they need to be removed from practice/competition and evaluated by medical personnel.

A couple other tips to help your kids succeed: keep an eye on hydration (all sports) and temperature (outdoor sports) - climate change is real and exposure to extended periods of extreme heat should be considered and planned for; check out the warm-up - a thorough warm-up is important to reduce injury; have the proper equipment - you don’t have to buy the most expensive options, just be sure shoes, clothing, gloves, etc fit well.

This is a light list of what to watch out for, but in my experience these cover the majority of trouble areas for most sporting activities. If you are a parent reading this, I hope that you feel encouraged and supported to raise the red flag when things are off. Just remember to trust your gut and ask questions.

Since you’re here: We have a small favor to ask! At SAPT, we are committed to sharing quality information that is both entertaining and compelling to help build better athletes. Please take a moment to share the articles on social media, engage us authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics.

Thank you! SAPT

Importance of Deceleration in Athletics

This is an excerpt from the recordings I do regularly to capture and share my ideas around performance, nutrition, and strength. It sounds conversational because it is. Enjoy!

“Importance of Deceleration

I’m really excited about the conditioning that we will be implementing this season, the heart rate monitors we are using are very advanced, giving me a lot of information during practice and weight training sessions. Outside of heart rate (HR) and different zones that we’re targeting I can see speed (mph), accelerations, decelerations, and time in each HR zone. Our goal for this season is to be as fit as possible, so having this information at my disposal is invaluable.

Having this data allows me to better mimic the demands of the sport in our conditioning sessions, without actually playing more basketball. I know what heart rate zones each player stays within during games, so I can adjust our training for that.

One of the really interesting things I’ve seen lately is looking at accelerations and decelerations. The acceleration and decelerations values fit into 4 categories based on if they are high or low threshold. I thought this was super telling, as none of my players went into the highest threshold of acceleration, which was 3 meters per second squared. On the other hand, everyone was decelerating at three meters per second squared or faster. This is so important and so fascinating.

This is not new information, just not a mainstream topic. What that means is that our players cant accelerate nearly as fast as they can decelerate. What I found last year was that one of our players with the most significant knee issues, that wasn’t necessarily the fastest, was the one that had the highest deceleration values! She was not even close to the fastest on the team in terms of acceleration, but would be able to and required to decelerate the fastest on the team.

That’s a very important information for us to know about this athlete. We have to learn to decelerate our bodies safely, and the best way to learn it is in the weight room. The best way I’ve found is with very controlled depth landings and depth drops. With these movements you are teaching the body to absorb force or decelerate in a controlled manner.

Another important point to discuss is that the majority of injuries in athletics happen during some sort of deceleration phase. These athletes have to control their body through these enormous forces, and we have to train for that. Just playing the sport doesn’t make you strong enough or fit enough to absorb these forces safely.

This is where overuse injuries come up, too. Typically when these things happen we say the glutes weren’t strong enough or the hamstrings weren’t strong enough to absorb that force. That may be true, but we also may not have given that athlete enough opportunities to practice high speed deceleration. Again the weight training is the base, but we have to give the athletes the opportunity to practice full speed deceleration in a controlled manner.

One of the easiest ways to do this is again just landing jumps. Step off of a box and stick the landing. It seems simple, but that’s usually the solution. The solution often isn’t doing lunge jumps in a sand pit, it’s the simple basic things that the athlete can work on. When looking at these kind of issues, the answer is generally a lot more simple than people think.
”

— Sarah Walls

Since you’re here: We have a small favor to ask! At SAPT, we are committed to sharing quality information that is both entertaining and compelling to help build better athletes. Please take a moment to share the articles on social media, engage us authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics.

Thank you! SAPT

Building Armor: Strength is Corrective

This is an excerpt from the recordings I do regularly to capture and share my ideas around performance, nutrition, and strength. It sounds conversational because it is. Enjoy!

Recently I did a presentation for the team on some pretty massive changes to training that I have been thinking about for the past year. I felt like now we could truly start to condition for the sport, we’ve had 2 years of working on the fundamentals and the team was beginning to get a good understanding of the basics.

What I really had to communicate to the team before we started using some more advanced methods was to remind them that strength is always our foundation, that’s what’s going to protect their bodies from getting hurt.

So, when we start doing the more advanced conditioning and somebody gets hurt (during a game… not in the weight room), or I see something I don’t like, they will immediately get pulled off of conditioning and back to strength.

If someone gets hurt, the first thing that we need to get done is get stronger in the area that was injured, as soon as we possibly can once the doctor or trainer says they are ready. But that's not four weeks, that's not even two weeks of inactivity, it's a few days, and then we quickly transition into building strength.

The touchstone in sports and athletics is always strength. As a foundation, we always have to come back to building strength. Your back hurts, let's get stronger. Your shoulder hurts, let's get stronger. Your knees hurt, let's get stronger, and let’s get stronger through a full range of motion. That is how your body stays healthy and safe. Of course, this is under the understanding that more major issues have already been ruled out and we can identify a strength deficit.

I like to think of strength training as building armor for the body. This doesn’t equate to growing huge muscles, especially for females. I’ve been strength training for the last 20 years, and by no means do I have tons of muscle mass. Yes, you will build some muscle, but there is a limit to that. So again, for women reading, you can trust your body to get as strong as possible, and not get enormous.

Another reason we lift weights is because it has an incredible effect on your tendons and your ligaments, making them thicker and stronger. It's not just the muscular strength that can help us reduce injury. It’s the other effects as well, such as thicker ligaments and tendons as well as bone density. This isn’t something we should start thinking about in our 40s and 50s, lets build these dense bones and thicker ligaments now. Let your children start to build those as young athletes. 

Another method that I see a lot of people using is they'll condition their athletes very hard. They then typically only use corrective exercises, the ones that you typically see during physical therapy. They're very targeted exercises designed to strengthen a very specific part of the body.

In most cases, they're not large multiple joint exercises but again more specific single joint exercise. There’s nothing wrong with corrective exercises, but they are a supplement not a staple. It’d be like your only nutrition being a protein shake, definitely not a long term plan that covers all of your bases.

First we squat, we deadlift, we do glute bridges, and we do lunges. Then let's add in some targeted correctives, some lateral side steps, deadbugs, clams… things that are used to build a little bit of strength and bring up what's very weak, but only if it's part of the larger performance program.

Since you’re here: We have a small favor to ask! At SAPT, we are committed to sharing quality information that is both entertaining and compelling to help build better athletes. Please take a moment to share the articles on social media, engage us authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics.

Thank you! SAPT

Breathing Drills

The foundation of our work with close to 100% of the population we work with begins with correcting breathing patterns. In a nutshell, here is why:

• Dramatic improvement in movement patterns 
• Fewer injuries
• Better recovery (between intense bouts and sessions)
• More bulletproof and awesome
• Sets the stage for building to athletic potential

When you or your child begin a training program at Strength & Performance Training, the first step is going through our advanced, unique, and cutting-edge evaluation. From the results of that evaluation, we begin the program design process. 

As with any evaluation process, the results impact the pathways that come thereafter. In the case of SAPT, their are varying levels of pathways. Each with their own sub-paths. Over our many years of working with athletes at every level and from every walk of life, we have been able to determine the pathways that lead to the greatest progress in the most efficient possible route.

Our first pathway, the one that is always prioritized as both foundational and necessary in all programs, is that of breathing patterns and drills.

Life Support

The human body really is a marvel. When given the proper conditions, it is capable of high-performance, the likes of which we have yet to see fully realized. While on the other end of the spectrum, given the “proper” conditions, the body is capable of adjusting and functioning in extremely unfavorable conditions. Great athletes can even thrive when everything about their lifestyle and training would indicate otherwise. 

The body can adjust to anything that does not actually kill it. We somehow manage to eat completely manufactured food-like products and still manage to think, write, walk. Humans have adapted to a lifestyle of sitting, when we were clearly designed for low-level ambulatory activity at most times. The examples can go on endlessly. 

As these adjustments occur, we generally tend to think everything is on the up-and-up in our bodies. Why walk, run, or bike from place to place when we can sit, relatively relaxed, in a motorized vehicle that quickly zips us from A to B? Sure, it is comfortable. But, when that sitting is complimented by another 8+ hours of sitting at school or work with an extra 3 hours reclined on the couch it starts to accumulate and effect your body negatively. The results - that you may only notice over time - include: poor circulation, atrophied gluteal muscles, low back pain, sciatica, rounded shoulders, forward head posture. All of which result in big time postural problems, predisposition to injury, and a myriad of physical and psychological problems. 

While it has become more generally accepted by the public that sitting = bad and moving = good, there is a lot more to this. The science of human performance is just that: Science. The research coming out every year is staggering and the knowledge that has developed just in the last 5-years is unbelievable. 

At SAPT, we only have human performance specialists on staff. Not hobbyists. Professionals. As such, our charge is to ensure that the programs and, ultimately, value we deliver to our clients must stand at the forefront of the industry. 

Since we’re diving right into science, let’s take a look back at the simple example of sitting = bad and moving = good. Okay, I agree. But, let’s take that deeper. Let’s be a little smarter about this and ask some more questions:

We know that the common mal-alignments in the body ultimately stem from poor pelvic balance and that is, in fact, causing the postural asymmetries.

But what causes this poor pelvic balance in the first place? Traditionally, we’ve chalked it up to an increasingly sedentary environment - too much sitting, not enough moving. Even for children. In fact this problem first develops in children, all children. 

Let’s go deeper still. There is actually something else going on besides our chair bound, screen driven environment. It just so happens that if you look very deep, like inside your body, you will discover that the muscle responsible for respiration, the diaphragm, is actually itself asymmetrical! In fact, the thorax is packed with asymmetrical situations: the heart sets on one side, the liver on the other to adjust the diaphragm is divided into two domes (on the right and left sides) one dome is smaller and weaker than the other. This sets off a precipitation of events. All of which ultimately influence our athletic performance, efficiency, injury patterns and more.

Posture

Let’s break this down a bit further. It’s important to grasp this point. If you can grasp this, then you will understand our methods: All kinds of important parts of the body attach and interact with the diaphragm. Since, by our bodies’ design, one side of the diaphragm is stronger than the other and that means that certain compensatory patterns always develop. Always. If you are a human you have these patterns. 

The diaphragm is stronger on the right side, this ultimately means that we favor (and overwork) the right side of the body. While the left side becomes weakened and inefficient. Similar to having a dominant hand, the right side of the diaphragm is everyone’s dominant side.

After understanding this as fact, we can see the commonplace asymmetries develop: one shoulder higher than the other, the rib cage set at predictable angles from right to left and front to back, the pelvis rotated predictably.

Injury Potential and Predictability

Alright, we’re getting back on solid footing. The by-design asymmetry of our diaphragm causes the postural asymmetries that cause, over time, injury. This is another fact.

How many times has a well meaning coach had an athlete statically stretch chronically tight hamstrings? Do they ever regain the proper ROM? Nope. But, those tight hamstrings are actually indicative of a risk for injury that points to pelvic misalignment and, you guessed it, points then towards diaphragm and thorax corrections that MUST occur before high performance can ever be achieved.

Another common example: How many times has a pitching coach focused their injury prevention program to address only the throwing side? Their thought being that they need to strengthen and protect the side of the body that gets worked all the time. WRONG. Good gracious that’s just layering on the problems. The body needs to be balanced out for high performance. 

Sub-Optimal Performance

Let’s continue to talk about the pitching coach who runs a one sided arm care program. Hey, it kind of makes sense. You throw with one arm, why wouldn’t focus on strengthening the musculature on just that side? 

Because over time you create many layers of dysfunction. These layers can be very hard to peel back in older, trained athletes. These layers will inevitably limit the lengths of their careers (from a physical standpoint).

Never, ever layer strength on top of dysfunction. The potential for injury skyrockets (that’s my opinion) and it becomes very difficult to make the foundational corrections (to backtrack). 

The result? The athlete has now gotten “stronger” and tighter and more imbalanced in the pursuit of increased performance. 

What should the approach have been? Fix the imbalances first, prioritize this as essential to performance, then and only then, begin to strengthen.

Respiration

When respiration isn’t occurring efficiently, an athlete’s ability to recover between bouts of training (or plays in a game) will be suboptimal. Potentially leading to injury, compromised decision making (think ability to read a developing play), lost points, or a Loss.

Gait

We’ve established that the diaphragm will cause poor pelvic balance. But what does that mean for gait?

“Walking and breathing are the foundations of movement and prerequisites for efficient, forceful, non-compensatory squatting, lunging, running, sprinting, leaping, hopping, or jumping ONLY WHEN three influential inputs are engaged: proprioception, referencing, and grounding.” [PRI coursework]

Pulled muscles, ligament tears, rolled ankles can all be traced back to a pelvis, and thus, breathing problems.

Turns out, that tilted and rotated pelvis can be a real problem!

How many great (or on their way to great) athletic careers have been stopped in their tracks by an injury?

How to fix: Zone of Apposition

Moving forward with the understanding that breathing really is the key to life, we have to ask: how do you fix this?

There is something called the Zone of Apposition (ZOA) and this is the area where the diaphragm and ribcage overlap each other. We want to maximize this overlap through proper ribcage positioning.

Here’s the good news: train the ribcage to be in the proper position and now those imbalances start to clear up. The benefits include:

• Better ROM at all joints
• Better recovery for bouts of work
• Less compensatory patterns throughout the body

Now we can work on performance!

How we use/integrate breathing drills to achieve performance improvements

Ground based:

Against gravity —> Static

Against gravity —> dynamic & sub-max: These drills are any movement in which we can take the opportunity to work on proper alignment of the ZOA and respiration while moving our bodies with or without load. A standing dumbbell shoulder press is an excellent example of a sub-maximal exercise that can be executed with consideration to breathing (or not).

Against gravity —> dynamic & max: again examples include actual lifts but this time at maximal effort or maximal speed. The deadlift is a good example. Taking the opportunity to set the ZOA is what ultimately will fire the core, protect the spine, and make for a more productive lift. And, YES, it IS possible to be very strong and execute max effort with perfect form!

What the athlete gets as a result:

• Better movement patterns (without forcing it)
• Fewer injuries
• Better recovery (between intense bouts and sessions)
• More bulletproof and awesome

It seems that to truly get what we want from our bodies, we need to first take care of some of the deepest considerations: diet, breath, mindset pop out to me. 

Running Sports: Groin Prehab

After experiencing, for the first time in my career, an athlete with a repeated groin injury. ***I understand groin injuries to be common, but honestly I'd not ever encountered many!*** I became obsessed with understanding the mechanisms for why this happened. As with most things with the body (biomechanically speaking), once you understand where one piece of the puzzle fits, the rest of the pieces fall into place.

In the old days of physical therapy, athletic training, and strength/conditioning, an injured muscle = a weak muscle. Identify the injured/weak muscle and strengthen it. Period.

Lots going on!

Once the pain went away, the advice from trainers and PT's was usually to keep stretching "the area is tight (oh, and weak, so keep strengthening too)." And the athlete would get sent back to S&C for continued strengthening of the weakened area and return to sport performance training. 

Unfortunately, more often that I'd like to count, the injury returned. Time and time again. The outlook for injured athletes, always seemed bleak. It always seemed this would be a nagging issue, no matter the severity.

Fortunately, we know better now - the olden days of working on strengthening injured muscles and looking no where else for dysfunction is over! Just kidding, this is still how most PT's and AT's approach injury.

Back to my injured athlete, after taking a look at her stride, I noticed a very significant hip drop. And a hip drop, boys and girls, is a prerequisite for a groin strain.

Now I knew where to get started. Getting the hips even in striding motions would be the solution. But, wait, there was something else needing attention first! In a previous post, I've called it Priority #1, check it out to understand how the zone of apposition must be corrected before moving into a prehab/rehab protocol.

Once the breathing patterns and rib positioning were improved, we were able to move on to working on preventing another strain.

Below I've got a couple samples of some of the drills we used. But no matter the actual drill, the theme here, and non-negotiable, was hip evenness. That was the main goal. Everything we did must come with even hips. Hips not even after cueing? Okay, that's fine, let's adjust the range of motion. So, as you look at the videos, please remember hip stability, control, and evenness are the top priority for an athlete when groin strain prehab/rehab are on the menu!

Beginner progression

The Single Leg Stance Series is a good option for someone who is recently out of their rehab protocol or can be easily used for a very specific warm-up to improve hip proprioception and and understanding of the relationship your foot has with the ground. 

Performance Injury Prevention

For a healthy athlete, this Groin Series gets a lot accomplished in just 3 movements. This series would NOT be appropriate for someone who is still in a weakened state. Rather, save this for when you've worked back to full health and strength and are looking to keep another groin injury at bay.

Groin injuries don't seem to get a lot of attention, but I think they should. Try a full speed deceleration, change of direction, or even acceleration the next time you've got one!

Coaching Vertical Jump with a Valgus Collapse

Ahhh, the knee cave, my old friend. This, by far, is the most common strength and movement pattern deficit I see in developing athletes. More officially known as a valgus position of the knee, it signifies not only a severe lack of specific and general strength, but also may be an indicator of poor body control overall (due to other common muscular strength deficits that generally come as part of the "package").

The valgus position, in my experience, is an oversized red flag waving high in the air. This red flag is warning of a looming knee ligament injury.

This is a very important topic, as most coaches, parents, and athletes have no idea how to correct the problem or even identify that it is a very big - and potentially dangerous - problem.

Check out the video where I break down film of an athlete in for training and discuss what I've found and how we're going to fix the problems: