More enlightened training environments (notably AltisWorld) are throwing light on the benefits of ready access to performance therapy on a daily basis at the training facility. Whilst a growing audience is taking note, the reality for the majority of athletes is that they remain in less evolved systems and training environments that lack this provision. For the unfortunate majority self-therapy tools offer a substitute to hands-on manual therapy. In part one of this post we made the selection of what self-therapy tools merit the precious space in an athlete's kit bag. In this follow-up post we will now discuss the what, when and how.
As we will explore, these tools have various applications in different instances; we will introduce some sample techniques and exercises to illustrate these applications and also to help guide athletes seeking to use these tools to best effect.
Due to the paucity of empirical evidence, these discussions are largely based on examples of best practice from leading practitioners and training environments, albeit we will touch upon what information is available from the sports medicine literature.
Let us recap the items that made the selection from part one. Front and centre, the make-your-own back balls (constructed from lacrosse balls and a sock). Item two is a standard yoga strap made from inelastic material with an adjustable locking buckle. The final item was a heavy resistance band.
Back Balls
The back balls are the first item out of the bag. A friend and former colleague (a sports physiotherapist named Chelsea Lane who at the time of writing is serving as Head Performance Therapist for Golden State Warriors in the NBA) has a strict rule that she will not allow any athlete under her care to lift until they have utilised the back balls in their warm up.
Accordingly, the athlete's routine upon arriving at the training facility or competition venue should be to spend some time on the back balls, working all segments from junction between lumbar spine and top of the pelvis to the top of the shoulder girdle (STOP there - i.e. avoid the neck). Adding (gentle) flexion/extension movements with either leg can also encourage the respective segments to mobilise. Similarly, by shifting to one side the back balls can also help to provide trigger point release for the muscles and connective structures adjacent to the spine.
The back balls are similarly a critical tool when the athlete is in transit, particularly on long haul flights. I would strongly encourage any athlete to pack the back balls in your hand luggage and take any and all opportunities to use them whilst waiting for flights. Similarly, the athlete should be diligent about using them once they have arrived at their destination to help work the kinks out before attempting to train or compete.
Isometric Effort Using the Yoga Strap (90-degrees Hip Flexion)
Isometric Effort Using Yoga Strap (10-degrees Hip Flexion)
Item two, the yoga strap, can be employed for a variety of functions. For instance, as we spoke about in part 1, this offers a priming tool for the muscles of the hip girdle. Once adjusted, the athlete can perform isometric efforts at 90-, 45- and 10-degrees.
Hip Roll Mobility Using Yoga Strap (90-degrees)
With the same set up the athlete can also perform hip rolls to mobilise the thoracic spine, whilst maintaining tension against the strap and therefore activation of abductor and external rotator muscles of the hip. Once again, this is performed at both 90-degrees and 45-degrees.
Hip Roll Mobility with Yoga Strap (45-degrees)
Note that these are just a couple of examples of applications for this piece of kit. The yoga strap is similarly a great tool for mobility work for the shoulder girdle, particularly for athletes in racquet sports, contact sports, aquatic sports. Likewise, the strap can be employed to assist when performing flexibility exercises for both upper and lower limb.
The final item in the self-therapy kit bag is the heavy resistance band. As well as a training device this is a great tool for mobilising the foot/ankle complex. This technique is particularly useful for track and field athletes, for whom foot/ankle mobility and impingement issues are relatively more common. Anecdotally, running-related conditions affecting the foot/ankle complex such as plantar fasciitis can also respond very favourably to this form of self-therapy, as part of the wider treatment regimen and reconditioning regime.
Foot/Ankle Self-Mobilisation Using Heavy Band
The heavy band is also a particularly useful therapeutic tool for the hip girdle. Athletes in a variety of different sports will be familiar with symptoms that fall under the umbrella diagnosis or syndrome termed femoral acetabular impingement (FAI).
“‘FAI’ is an anatomical variant, a morphological state often related to imposed demand. It is hardly a diagnostic term.”
Given the prevalence of conditions diagnosed as 'FAI' in many sports (including among young athletes) conservative management that includes manual therapy is increasingly promoted, particularly in cases where there is no secondary joint damage that necessitates surgical intervention.
The major objective of the conservative management employed is to improve joint function. To that end, manual therapy often comprises joint mobilisation to provide more normal joint spacing and restore posterior glide of the head of the femur in the hip socket. To assist, traction may be applied in a lateral or posterior direction during hip joint mobilisations.
The heavy band can be utilised in a similar way to provide traction during self therapy. Heavy band distraction is employed in appropriate postures and as an adjunct to flexibility exercises in a way that may offer relief for these symptoms and acute improvements in function. In much the same way as with standard manual therapy, this type of self-therapy can hereby serve a critical supporting role in enabling the athlete to perform the necessary training to improve the strength and dynamic stability afforded by the muscles of the hip. Self-therapy when employed in this way can thus support and facilitate the intervention that provides more lasting improvements in function and symptoms.
Heavy Band Distraction (applied posteriorly) in Standing Forward Flexion
Heavy Band Distraction During Triangle Stretch
So there we have it, some examples of daily applications of the self-therapy tools we selected for the athlete's kit bag. These tools and self-therapy techniques are particularly useful when applied alongside a daily mobility and pre-workout routine that serves as a self-screening or monitoring tool for the athlete. This practice and examples of dynamic warm up protocols employed for screening purposes in the field will be the topic of a future post. Stay tuned...