Stake Your Claim to Cortical Real Estate For Injury Prevention and Improved Performance

 Last weekend, I completed the final class of a six month course, Advanced Functional Biomechanics of the Lower Quarter Principles of Evaluation and Treatment. (That’s a mouthful.) In the following two part post, I will share highlights from the final class, which focused on strategies to develop an individualized, effective functional movement strength program. This intricately tiered progressive program can be tailored as a return to sport, injury prevention or improved performance protocol.  Part I focuses on specific aspects of this progression. Part II will focus on effective coaching techniques to support skill practice, training and retention.

This six month fellowship took place with Dr. Chris Powers, an Associate Professor in the Department of Biokinesiology & Physical Therapy, and Co-Director of the Musculoskeletal Biomechanics Research Lab at USC. He recently opened, in conjunction with USC, and directs the Movement Performance Institute (MPI), a state-of-the-art biomechanics lab.

This comprehensive six month course significantly enhanced the depth and scope of the return to sport, injury prevention and performance strategies I employ in my coaching and performance training programs. It was a knowledge-altering experience. These research-authenticated concepts provide the tools to develop cutting-edge programs to assist a range of clients, from those returning from injury to competitive endurance athletes and those seeking improved fitness through a safe and effective conditioning program.

The class reinforced the o2fitness mission to help athletes understand the importance of a balanced, progressively structured, less is more fitness approach. Whether an endurance or fitness-conditioning goal – results rest on a well-developed, systematic plan. It is ultimately how the plan is implemented that reaps the rewards. The difference in training and conditioning effectiveness is the athlete’s understanding of the why of training. This understanding is pivotal to motivation, which results in fully committed, purposeful workouts.

The athlete’s willingness to change the training mindset from more is better, to better is better is the final key to successful results.

This quality-centric training approach presents the polar opposite of the quantity over quality, trend of the day of of  many boot camps, cross fit and insanity type workouts, which are proving to be job security for physical therapists. 

At the last class, Dr. Powers presented a research-proven progression for an effective functional strength and movement program. This approach can be applied to the injured athlete striving to return to sport as well as athletes seeking the ethical edge for improved performance. This program is applicable to a range of athletes from those in team sports and endurance cycling and running to those seeking a safe and effective general fitness/conditioning program. many boot camps, cross fit and insanity type workouts, which are proving to be  job security for physical therapists. 

In all cases, however, the success of the program, whether a return-to-sport or performance-focus, relies upon consistent diligent practice.

Power’s program is divided in to three objectives – activation, strength, and movement education, and consists of eight levels. As with all good programs, it starts with more simple static maneuvers, and as the movements are mastered, gradually advances the movement complexity. The eight-level program is broken in to three sections – static, dynamic and ballistic. Within these three sections, the exercises are further dissected – non-weight bearing, static; weight bearing static; double limb dynamic; single limb dynamic; double limb ballistic; and single limb ballistic. The eight-tiered program concludes with sport specific movement and skill training.

The reoccurring theme over the six month fellowship has been the lack of hip (gluteus medius and gluteus maximus) stability as the major culprit of lower extremity injuries and dysfunction leading to potential injury. Powers contends that the lack of hip stability results from our sedentary lives and state of perpetual flexion, leading to a quad dominant movement strategy. This chronic closed state shuts off our ability to feel, find and activate our glutes, creating a downward spiral in strength and consequently greater reliance on the quads.

 USC Professor, Dr. Fischer presented her research on, among other aspects, our ability to remap our cortex – and acquire greater real estate for specific body parts. For example, the hips, and all postural muscles for that matter, have a relatively small representation on the cortex.

During the six month class Powers has presented his 10 years of research which clearly connects poor hip strength to internal rotation, hip adduction and pelvic instability leading to, among other issues, Based on Fischer’s research findings, Dr. Powers initiates his functional movement program with static isometric exercises that effectively isolate and activate the gluteus maximus and gluteus medius. The reasoning is simple – you cannot strengthen a muscle that you cannot feel. The static exercises push the exertion limits and demand concentrated mental engagement, which results in cognitive growth. Prematurely adding a dynamic nature to the exercises proves detrimentally distracting if the muscle activation has not been well-instituted. By effectively isolating and activating the glutes we grow its cortical real estate. Once you have purchased additional real estate – you then develop it. When it comes to purchasing and developing cortical gluteus real estate, mini-band exercises are money. 

knee valgus. This dysfunction contributes to numerous injuries and pain including patella femoral, ACL and IT band issues. As a result of this research and resulting hip to lower extremity connection – hip stability and re-educated movement strategies take center stage in Power's program. That said, this integrated program also rests on principles of trunk and pelvis stability, as well as active shock absorption.

In the exercises that incorporate the mini-bands, the bands are over the knees and in most cases, athletes are placed in a flexed hip, knee and ankle position. The exercises in the intitial phases focus on isolating, activating and strengthening the gluteus medius and maximus, while limiting tensor fascia latae muscle activity.

Level one, non-weight bearing static transitions to level two weight bearing, double limb static exercises. In weight bearing we lose the ability to isolate – so it is important to have established the isolation and activation in level one. In these exercises body position including femur, tibia and trunk angles become key. Cues to properly guide bo

Level three progresses to weight bearing single leg static exercises – same cues as above – and oh yeah remember to breath. dy position and achieve optimal isolation and activation – include hips back and down, positive shin angle, slight trunk lean with chest in line with knees (with the exception for those with long femurs/short torsos), as well as the continual reminder to push out with the knees against the mini-band resulting in the knees over the toes in the frontal plane.

Levels one through four are slow and controlled. Levels five and six are balistic in nature to train a quick dynamic interaction between the extremity and ground. These levels train strength and its ability to apply/produce a rapid rate of force, which is directly applicable to performance.

Level seven starts to focus on movement education and prioritizes – hip, pelvis and trunk stability; and hip strategy for active shock absorption. 

The program concludes by incorporating the trained pieces – activation; safe and effective body position; improved muscle strength, power and performance; and movement re-education utilizing the trained strength,  power and endurance to hone sport specific skills.

Part II will focus on coaching techniques to maximize movement education and skill development.