Isometric acad

(another long one, buckle up)
As a society today, we have never been more connected. Our jobs are now easier through the wealth of technology and automation – however, it has been taking it’s told on public health.
For the working sector, we are now less active and spending less time engaged in physical activity. Physical education and after-school sports programs are being trimmed from school budgets and our children are increasingly likely to become obese.
Information from the Center for Disease Control and Prevention (2003, 2005) as well as researchers Fegal et al. (2010) and Ogden et al. (2010). Notate that nearly one-third of adults today are estimated to become obese; one-fifth of adolescents and teenagers are estimated to become obese; and that this new trend is predisposing individuals to reduced physical activity, poorer health and an increase in injury rates.
A New Trend Emerges: Rationale for Corrective Exercise
It is understood that decreased physical activity lends itself to muscular dysfunction and potential injury. After all, if we rest, we rust. Low Back Pain Researchers Walker et al. (2004) and Cassidy et al. (1998) note that nearly 80% of adults will experience musculoskeletal degeneration and subsequent lower back pain at some point during their lives. Further, Nadler et al. (2000) note low back pain is predominant among workers in enclosed spaces (i.e. office workers), those engaged in manual labor, those who sit for longer than 3 hours, and those with a greater lumbar lordosis. Fiscally, lower back pain accounts for estimated costs approaching $26 billion (workers comp, lost work days, decreased business productivity). Finally, it is noted by Nadler et al (2000) that 6 – 15% of athletes experience lower back pain in a given year.
Shoulder Pain
Barr et al. (2005) noted that shoulder pain is present in 21% of the general population with 40% persisting for at least 1 year, with an estimated cost of $39 billion, annually (again – workers comp cases, lost work days, and decreased business productivity). Shoulder impingement is considered to be one of the most prevalent diagnoses, accounting for 40 – 65% of reported shoulder pain cases. The above researchers base their information based on meta-analysis and conclude that populations of untrained or undertrained individuals promote the risk for potential injury. Further, they note that weakened structures as a result of an under-trained, or non-trained individual will result in poor responses to conditional or musculoskeletal training regimens. This means that programs given to employees or individuals as a result to correct a shoulder issue may, in fact, exacerbate symptoms owing to their lack of training and / or sedentary lifestyle.
Lower Extremity Pain
Continuing with the aforementioned injuries, lower extremity pain to the foot, ankle and knees are not immune either. Hosea et al. (2000) note ankle sprains, for example are reported as most-common sports-related injury, with lateral ankle sprains increasing the risk for chronic ankle instability in later life. Further, the above-authors note compensatory injury development into the hip-region, following ankle pain.
With respect to knee injuries, Griffin et al. (2000) surmised that of the 80,000 – 100,000 knee injuries pertaining to ACL injuries occurring annually in the United States, 70 – 75% of these are the result of non-contact / non-sport injuries. The authors note that the majority of knee injuries among sport-playing athletes occur between 15 – 25 years of age, and that there is a strong correlation to arthritic degeneration to knee in later life.
A Solution to an Ever-Growing Problem
Through the researchers above, we see a need for today’s populous to opt for a trend that favors the reduction of injuries and the promotion of health through work and sport. We recognize a trend towards non-functional living and exercise; and health care professionals are continuing to push for a world that addresses these issues.
Too long have continued decreases in everyday activities of daily living resulted in postural deficiencies among our working forces. Further, due to the increased stressors and demands of the everyday working man and woman (we’ve not even considered the nutritional issues trending toward the Standard American Diet here), today’s training programs must differ from those designed from decades prior, as they no longer meet our current needs if we are to correct these imbalances in a timely manner.
By addressing movement imbalances and functional deficiencies, we can begin to design corrective exercise programs for individuals to meet their individual needs. The definition of corrective exercise describes the systematic process of identifying key neuromuscular dysfunction and developing an action plan to correct these problems through an integrative and corrective protocol.
Corrective Exercise
As defined by the National Academy of Sports Medicine, there are four components when designing a corrective exercise protocol: inhibition, lengthening, activation and integration.
Inhibition – refers to over-active muscle groups that are causing undue tension to other areas and causing dysfunction. Myofascial release techniques are implemented here to decrease overactivity.
Lengthen – second, often times muscles that have been chronically shortened as a direct result of over-active muscle groups need to be addressed in order to promote flexibility, elasticity and improved range of motion. Dynamic or static stretching may be implemented here.
Activation – third, muscles which have been inactive, or under-activated (as a result of over-active muscles) are best served through positional (isometric) corrective exercises, as well as isolated strengthening.
Integration – fourth and finally, this phase encompasses the above-three phases. Once the over-active muscles have been regulated and underactive tissues strengthened, an athlete can begin to implement advanced exercises and activities that will promote synergy between all muscle groups, both antagonistic and agonistic.
Case Example: An athlete with documented collapsed (pronated) arches with bilateral lower extremity soreness.
This would be an athlete with potential for a ‘knock kneed’ stance. Short muscles here may include the gastrochnemius and soleus. Lengthened muscles may include the tibialis anterior and posterior, respectively. Altered joint mechanics would include knee adduction / internal rotation. Patient would complain of potential ‘shin splints’, plantar fasciitis as well as medial patellar tendonitis (or MCL pain).
Using the above protocols, lengthening the gastroch-soleus complex through myofascial release, strengthening the tibilais anterior and poster muscle groups through isometric – then concentric exercises – and finally putting it all together in the form of a strength and conditioning program will result in the likelihood of an athlete or individual with minimized lower extremity pain.
Prehab Before Rehab, everyone.
References:
Barr, K.P., Griggs, M. & Cadby, T. 2005. Lumbar stabilization: core concepts and current literature, part 1. Am J Phys Med Rehabil. 84: 473 – 480.
Cassidy, J.D., Carroll, L.J. & Cote, P. 1998. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine. 1998. 23: 1860 – 1866.
Centers for Disease Control and Prevention. 2003. Prevalence of physical activity, including lifestyle activites among adults – United States, 2000-2001. Morbid Mortal Weakly Rep. 52: 764 – 769.
Centers for Disease Control and Prevention. 2005. The burden of obesity in the United States: a problem of massive proportions. Chronic Dis Notes Rep. 17: 4 – 9.
Flegal, K.M., Carroll, M.D., Ogden, C.L. & Curtin, L.R. 2010. Prevalence and trends in obesity among US adults: 1999 – 2008. JAMA. 303: 235 – 241.
Griffin, L.Y. et al. 2000. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. 8: 141 – 150.
Hosea, T.M, Carrey, C.C. & Harrer, M.F. 2000. The gender issue: epidemiology of knee and ankle injuries in high school and college players. Clin Orthop Relat Res. 372: 45 – 49.
Nadler, et al. 2000. The relationship between lower extremity injury, low back pain, and hip muscle strength in male and female collegiate athletes.Clin J Sport Med. 10: 89 – 97.
Ogden, C.L., Carroll, M.D., Curtin, L.R., Lamb, M.M. & Flegal, K.M. 2010. Prevalance of high body mass index in US children and adolescens, 2007 – 2008. JAMA. 303: 242 – 249.
Walker, B.F., Muller, R. & Grant, W.D. 2004. Low back pain in Australian adults: prevalence and associated disability. JMPT. 27: 238 – 244.