Nick grantham

an interdisciplinary approach to the hip and groin

Nick Grantham Performance Enhancement Specialist MSc, CSCS, ASCC Monday, 23 May 16

operate at

80% 60%

of players of their capacity

Monday, 23 May 16

operate at

80% 60%

of players of their capacity

Monday, 23 May 16

operate at

80% 60%

of players of their capacity

Monday, 23 May 16

operate at

80% 60%

of players of their capacity

Monday, 23 May 16

operate at

80% 60%

CONTRAST

what have they got in the bank?

what are they prepared for?

of players of their capacity

Monday, 23 May 16

aggregation of marginal gains Alasdair Lane - Lead Out Coaching Why the Marginal Gains Concept Fails in Football September 2015 Monday, 23 May 16

aggregation figure out why the basics that give the of marginal biggest returns aren’t being done gains and then find a solution Alasdair Lane - Lead Out Coaching Why the Marginal Gains Concept Fails in Football September 2015

Monday, 23 May 16

Monday, 23 May 16

Gabbett TJ. Br J sports Med 2016

Monday, 23 May 16

greater resilience

Gabbett TJ. Br J sports Med 2016

Monday, 23 May 16

greater resilience

well-developed physical qualities are associated with a reduced risk of injury

under-training may increase injury risk

Gabbett TJ. Br J sports Med 2016

Monday, 23 May 16

the problem is not with training per se, but more likely the inappropriate training that is being

prescribed. greater resilience

well-developed physical qualities are associated with a reduced risk of injury

under-training may increase injury risk

Gabbett TJ. Br J sports Med 2016

Unimodal rehabilitation interventions and generic rehabilitation prescription based solely on evidencebased medicine are unlikely to be optimal in the rehabilitation of injuries particularly in athletes Scott A, et al, Br J sports Med 2013

Monday, 23 May 16

Monday, 23 May 16

focusing on injury mechanism may be more productive rather than attempting to isolate individual pathological structures.

Athletic groin pain ( part 1): a prospective anatomical diagnosis of 382 patients clinical findings, MRI findings and patient-reported outcome measures at baseline Falvey ÉC, King E, Kinsella S, et al. Br J Sports Med

Monday, 23 May 16

TOO MUCH

TOO FAR

Inability to tolerate the force generating or force dissipating demands of a muscle action

Inability to tolerate the required working range of motion of a muscle action

focusing on injury mechanism may be more productive rather than attempting to isolate individual pathological structures.

Athletic groin pain ( part 1): a prospective anatomical diagnosis of 382 patients clinical findings, MRI findings and patient-reported outcome measures at baseline Falvey ÉC, King E, Kinsella S, et al. Br J Sports Med

Monday, 23 May 16

optimal function

efficient load transfer through range of motion

Monday, 23 May 16

Developing an appropriate strength training programme for your athlete is based on three elements

Monday, 23 May 16

Developing an appropriate strength training programme for your athlete is based on three elements

Understanding the strength requirements

Monday, 23 May 16

Developing an appropriate strength training programme for your athlete is based on three elements

Understanding the strength requirements

Knowledge of the most appropriate training techniques to develop those strength requirements

Monday, 23 May 16

Developing an appropriate strength training programme for your athlete is based on three elements

Understanding the strength requirements

Knowledge of the most appropriate training techniques to develop those strength requirements

Understanding how these training strategies should be incorporated into a long-term plan [phase potentiation]

Monday, 23 May 16

Histories of intense sports activities that require abrupt acceleration, kicking, rapid alternation of single-leg load bearing, abrupt changes in direction and circular movement of the trunk are generally present, and groin pain is a common reason why top-level athletes may be kept away from their sport.

Rodrigo Castelo Branco, CĂŠsar Rubens da Costa Fontenelle, Leandro Marques Miranda, Yonder Archanjo Ching San Junior, Evandro Miguelote Vianna, Rev Bras Ortop. 2010;45(6):596-600

tend to neglect the muscles responsible for the other important hip movements Agonist Muscles

Hip Muscle Anatomy

is not the magic number neither is 3

1 Anatomical Movements

Gluteus maximus, biceps femoris (long head), semitendinosus, semimembranosus

Tensor fasciae latae, gluteus medius, gluteus minimus, sartorius

Hip Extension

Hip Abduction

Adductor magnus, adductor longus, adductor brevis, gracilis, pectineus

Iliopsoas, rectus femoris, sartorius, pectineus

Hip Adduction

Gluteus medius (anterior fibers), gluteus minimus, semitendinosus, semimembranosus, gracilis

Hip Flexion

Hip Internal Rotation Hip External Rotation

Iliopsoas, gluteus maximus, gluteus medius (posterior fibers), biceps femoris (long head), sartorius, gemellus superior, gemellus inferior, obturator externus, obturator internus, quadratus femoris, piriformis

Importance of Comprehensive Hip Strengthening Holcomb, M.G., Miller W.R. and Rubley M.D 2012, Strength and Conditioning Journal 34 (1)16-19 Monday, 23 May 16

Monday, 23 May 16

Power of Six [1] [2] [3] [4] [5] [6]

Monday, 23 May 16

Power of Six

obsessed with adductors

obsessed with extensors

[1]Flexion [2]Extension [3]Adduction [4]Abduction [5]Internal Rotation [6]External Rotation

multi-planar conditioning

Monday, 23 May 16

Beyond 3 sets of 10

training within a specific repetition range will produce specific adaptations

V B T ≤0.75m/s

strength speed

strength

moderate loads moderate velocity

heavy load slow velocity

Beyond 3 sets of 10

13 14 15+

training within a specific repetition range will produce specific adaptations

9 10 11 12

MUSCULAR ENDURANCE AND LIMITED HYPERTROPHY

METABOLIC [CELLULAR] SETS [LOW 2-4]

OPTIMAL HYPERTROPHY

very light loads high velocity

light loads high velocity

0.75-1.0m/s

ABSOLUTE STRENGTH AND HYPERTROPHY

678

speed

1.0m/s-1.3m/s speed strength ≥1.3m/s

adapted from Bryan Mann

12345 RELATIVE STRENGTH

NEURAL [NEUROMUSCULAR] SETS [HIGH 5-12] Monday, 23 May 16

Adapted from Duncan French, 2015

Conditioning Strategy

Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16

Adapted from Duncan French, 2015

BW activation Dynamic resisted control Dynamic high load resisted

Conditioning Strategy

Corrective

Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16

Adapted from Duncan French, 2015

BW activation Dynamic resisted control Dynamic high load resisted

Static flexion and extension Dynamic flexion and extension Dynamic multi-planar

Conditioning Strategy

Flexibility and Mobility Corrective

Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16

Adapted from Duncan French, 2015

BW activation Dynamic resisted control Dynamic high load resisted

Static flexion and extension Dynamic flexion and extension Dynamic multi-planar

Short lever - low load - low velocity Long lever - high velocity low load Long lever high velocity high load

Conditioning Strategy

Unilateral Stability Flexibility and Mobility Corrective

Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16

Closed-chain flexion Open-chain flexion Open chain flexion-adduction

Conditioning Strategy

Unilateral Strength

Short lever - low load - low velocity Long lever - high velocity low load Long lever high velocity high load

Adapted from Duncan French, 2015

BW activation Dynamic resisted control Dynamic high load resisted

Static flexion and extension Dynamic flexion and extension Dynamic multi-planar

Unilateral Stability Flexibility and Mobility Corrective

Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16

Conditioning

Closed-chain flexion Open-chain flexion Open chain flexion-adduction

Lateral conditioning Resisted lateral conditioning COD / reactive agility

Conditioning Strategy

Unilateral Strength

Short lever - low load - low velocity Long lever - high velocity low load Long lever high velocity high load

Adapted from Duncan French, 2015

BW activation Dynamic resisted control Dynamic high load resisted

Static flexion and extension Dynamic flexion and extension Dynamic multi-planar

Unilateral Stability Flexibility and Mobility Corrective

Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16

Conditioning Strategy

Lateral conditioning Resisted lateral conditioning COD / reactive agility

Heavy eccentric control High impulse eccentrics Coupling (concentric/eccentric)

Conditioning

Closed-chain flexion Open-chain flexion Open chain flexion-adduction

High Impulse Loading

Unilateral Strength

Short lever - low load - low velocity Long lever - high velocity low load Long lever high velocity high load

Adapted from Duncan French, 2015

BW activation Dynamic resisted control Dynamic high load resisted

Static flexion and extension Dynamic flexion and extension Dynamic multi-planar

Unilateral Stability Flexibility and Mobility Corrective

Importance of Comprehensive Hip Strengthening 2012 Holcomb, WR, Miller M.G. and Rubley, M.D, Strength and Conditioning Journal, Volume 34, (1) Monday, 23 May 16

Corrective Build on a foundation of pelvic alignment and muscle balance through loading

Flexibility and Mobility

Avoid simply performing traditional frontal plane movements

Unilateral Stability

you can’t fire a cannon out of a canoe - stability is control in the presence of change

Monday, 23 May 16

MOVEMENT QUALITY TRAINING - 1 Order Exercise Sets/Reps 1 Psoas Raise 5s-5s-5s-5s-5s-5s 2 Mini-Band Diagonals 10-10-10 ea 3 Groin Squeeze 10-10-10 ea 4 Offset 10-10ea Squat 5 Wide 10-10 6 Rot Squat 10-10 - All squat exercises are performed without external loading (bodyweight only) - Technique must be ‘flawless’ at all times

A-Wall Drills

MOVEMENT QUALITY TRAINING - 3 Exercise Sets/Reps Iso Psoas Raise 2s-2s-2s-2s-2s Mini-Band Side Steps - Athletic10-10-10 Athletic ea Walking 10-10-10-10-10 ea A Drills Drives 10-10-10-10-10 ea Iso Hold 15s-15s-15s-15s ea Switch + Hold5s-5s-5s-5s-5s-5s

MOVEMENT QUALITY TRAINING - 2 Order Exercise Sets/Reps 1 Seated Psoas Raise 5s-5s-5s-5s-5s-5s 2 Mini-Band Side Steps 10-10-10 ea 3 Keiser Adductor 20-20ea 4 Lateral 10-10 ea Lunge 5 Backward 10-10 ea 6 Drop 10-10 ea - All lunge exercises are performed without external loading (bodyweight only) - Technique must be ‘flawless’ at all times

Order 1 2 3 4 5 6

- Technique must be ‘flawless’ at all times

Unilateral Strength too much reliance on closed chain conditioning strategies

Conditioning

STRENGTH AND POWER - 1

Order Exercise Coaching Cue 1 Back Squat Weight through whole of foot 2 Gymaware - CMJ 3 Stiff Leg Deadlift Maintain good posture 4 Hip Thrust Squeeze glutes at top 5 SB Adductor Slide board - control 6 Sway Maintain athletic position and posture

STRENGTH AND POWER - 2

Sets/Reps Tempo Recovery 8-8-5-5 10X 30 5-5-5-5 X 120 8-8-5-5 10X 120 10-10-10 101 60 30s-30s-30s 1 0 1 60 10-10-10ea 111 60

Exercise

2 x 6 ea

3 x 10s

3 x 10s ea

2 x 10 ea

2 x 10 ea

2 x 10 ea

Sessions 1 - 4

2 x 6 ea

2 x 6 ea

3 x 15s

3 x 15s ea

3 x 10 ea

3 x 10 ea

3 x 10 ea

Sessions 5 - 8

2x6

1 x 6 ea

2 x 6 ea

3 x 20s

3 x 20s ea

3 x 10 ea

3 x 10 ea

3 x 10 ea

Sessions 9 - 12

Tempo Recovery 10X 60 X2 60 XX1 60 121 60 111 60 111 60

High Knee

-

1x6

3 x 15s

Sets/Reps 8-8-5-5ea 5-5-5-5ea 5-5-5-5ea 6-6-6-6ea 10-10-10ea 10-10-10ea

Heel Lift

-

-

RUNNING MECHANICS

Leg Drives

Switch - triple

-

Acceleration Switch - single Wall Drill Switch - double

March

Switch - continuos

Iso Holds

Order Exercise Coaching Cue 1 RFE Split Squat Maintain knee alignment 2 Split Squat Drop Alternate right and left 3 SL SLDL + LungeDynamic - fast switch 4 SL Bridge Foot on box, knee bent - hold for 2s 5 Sway Maintain athletic position and posture 6 Step + Sway Stay low throughout

Not as simple as strengthening adductors and lengthening abductors – think multi-planar

High Impulse Loading

Progressive overload to high impulse stabilisation and strength

Monday, 23 May 16

Monday, 23 May 16

Monday, 23 May 16

the athlete will regret not training the movements, speeds and loads that resulted in the injury

Monday, 23 May 16

players simply need to adopt a chronic training strategy

Monday, 23 May 16

the need for instant results disrupts continuity

Mark Gillett Richie Rawlins Andrew Leaver Fraser McKinney Matt Green Paul Caldbeck Simon Griffiths George Kiss Fergus Ross *Steve Wright *Chris Barnes *Mark Jarvis *Rick Carter *Paul Brice Monday, 23 May 16

Monday, 23 May 16

I hope today has been of real value Thank you [E] nick@nickgrantham.com [T] @coachnickg