If I had one goal for this lecture, it would be to inspire you to look at the body in a different manner. I want you to take a step back from conventional wisdom and the ways in which we have viewed and analyzed the body in the past. It’s time to take off the blinders and really understand our bodies through a new medium – the looking glass of human movement.
Today we live in a performance driven culture. Every year Fortune magazine boasts the famous “Fortune 500 list” ranking the top 500 corporations in the United States based solely on their total revenue. Our current paradigm is centered around what we can achieve and accomplish if we just do X,Y, and Z. It’s of no wonder that the American win-at-all-cost culture has penetrated every aspect of our lives – including sports.
The mantra “Bigger, Faster, Stronger” is echoed in every aspect of sport performance today. The idea of lifting more weight, running the faster time, and setting the next record has consumed us for decades – a testament to who we are as a society. Has it been effective? You bet. Just look at the 2012 Olympic games and search for how many world records were set. The answer is 32 new world records. However, even after all of the performance advances we have made the past years, the faster times, the more weight lifted, the increased yardage ran, there was still something missing. Despite the accolades and honors, athletes kept getting injured at an alarming rate.
For example, injury to the anterior cruicate ligament (ACL) has been labeled as one of the most serious season-ending injuries in all of sports today. Let me throw up a few numbers to explain this phenomenon
- An estimated 100,000 ACL tears will happen this year in the United States (1).
- Nearly 2/3 of these injuries are non-contact – meaning the injury did not involve any contact with another player (2,3)
- Girls who play soccer and basketball are currently tearing their ACL 3 times more than boys (1).
- Research has shown that roughly 5% of all girls who play year round basketball and soccer will sustain a tear to their ACL at some point in their career! (1).
You see, the issue is not that our athletes are too big, too fast, or too strong – those are all part of normal human evolution in a performance driven society – but it is that they have become so in a way that is not supported by their fundamental movement foundation. Ask yourself if any of these situations sound familiar to you.
- You notice a large powerlifter at your gym that can squat 700 pounds in the back squat, however struggles to perform a basic front squat because of his poor mobility restrictions?
- You know a football player with knee pain – he can back squat 500 lbs but cannot perform a basic pistol squat without his knee wobbling around uncontrollably.
- You observe a weightlifter who can clean & jerk 400 lbs, but allows their knees to roll in on the ascent portion of the clean movement.
- A strength coach tells you that learning how to perform a pistol squat is a waste of your time because you will never need to get into that position playing football.
Anyone? Unfortunately these situations are all too common occurrences in our culture of performance.
Conventional medical wisdom would have us believe the solution to understanding these injuries is due to a multitude of complex and complicated factors. Experts in the field of sports medicine have led us to believe these injuries were occurring because athletes’ hamstrings weren’t strong enough; they said females were tearing their ACL at a higher rate because they had wider hips (leading to something we can measure called a Q angle). Some have even gone so invasive as to say that athletes tear their ACL because the ligament itself may be getting impinged against the medial border of the intercondylar notch of the knee. While all of these factors may be associated in the manner of injuring the knee, these medical professionals are unfortunately looking at the body through a microscope – never realizing the big picture. The answer was right in front of them. The one determining factor that unites each and every athlete who injures their ACL in a non-contact method is the inability to control the body during a squat. Period. It’s a movement issue.
What if I told you we could eliminate roughly 70,000 torn ACL injuries every year by teaching our athletes how to squat properly? As a doctor of physical therapy, I have the opportunity on a daily basis to observe the quality of movement with athletes of all ages and skill sets. While working at Boost Physical Therapy & Sport Performance I have been able to evaluate and treat over 75 cases of ACL rupture and subsequent surgical repair in the past 3 years. This has led to an accumulation of over 6,000 hours in contact time understanding and treating athletes with this injury. From the high school female soccer player to the NFL cornerback there is one constant that connects them all.
For a young female soccer player, a torn ACL can be extremely debilitating, both physically and mentally. A season-ending injury like this eliminates roughly 25% of that athletes’ high school career. Competitive soccer today is one of the most popular and time-demanding sports for today’s youth. It is not uncommon for an athlete of this caliber to donate a minimum 6 hours every single week to participating in numerous practices and games. A typical schedule for a competitive soccer player would include 3 two hour practices a week, 2 one hour sessions of skill work on top of practice, all followed by 2-3 one hour long games every single weekend. A high level of skill is demanded to play at this level and most youth at this level spend hours every week improving their ability to play the sport they love.
The NFL is full of the nations best athletes – hands down. Only a select few are lucky and talented enough to don a NFL jersey and stand on the sidelines on Sunday afternoon. Less than 1% of high school football players will eventually make it to the NFL. They are big, they are strong, and they are extremely fast. The NFL is quintessentially the pillar of elite athleticism in American society. At this level, performance on the field can mean the difference between being cut and sent home or a million dollar deal and company endorsements that will set a player up for a lifetime of financial stability. An ACL tear therefore can be extremely damaging, physically, mentally and financially.
While both of these athletes sustained this same injury at different stages in their sporting careers, they also had one common connection that is usually less recognized – they could not squat well. They could not perform a deep bodyweight squat with adequate ankle and hip mobility, proper joint alignment or muscular coordination. A large majority of each of their rehabilitation was spent learning how to perform a bodyweight squat and a single leg pistol squat. Most people would think these athletes, both advanced in skill within their respective sports, would be able to perform these simple movements with ease.
The case I’m trying to make with these two athletes is the same phenomenon I see with almost every single athlete I have seen who has sustained the same injury. These athletes didn’t sustain their injury because they are weak. These two athletes, just like the thousands that sustain the same ACL tear every single year, spend hours upon hours during the week at the gym or on the training field working on improving their physical capacity to run faster, jump higher, and lift more weight. We as a society value quantity and objective numbers over quality and process. Too often we place too much emphasis how much weight is on the bar when the athlete can’t even perform a basic bodyweight squat or pistol squat to full depth without falling over.
Our performance driven culture has placed such an emphasis on performance that we have conceptually re-arranged our athletic priorities. More often than not athletes are willing to sacrifice movement in order to perform. After all is said and done we cannot escape the need for movement competency. This concept of movement competency can be described as the ability for an individual to move without pain or discomfort and with proper joint alignment, muscular coordination and posture (4).
Now I’m not saying that the grind of training for performance is not important. What I am saying is that we need to ensure our physical capacity (our strength, our power, our endurance) and our skill does not exceed our ability to move. This starts by solidifying the foundation for our athletic bodies – this starts with movement competency. Being able to show competency in our fundamental and functional movement patterns, such as our ability to perform a deep squat with correct joint alignment and muscular coordination, creates a foundation for which strength and skill are predicated upon. Food for thought, barbell training is one of the most important ways in which we can challenge our body to maintain competency and integrity of our functional movement patterns. Move first and perform second.
If we are unable to move efficiently with good technique in the squat (especially without a barbell) we essentially set ourselves up for failure. Performance wise we limit our potential to produce efficient force and power. We also increase our susceptibility to injury because our physical capacity is resting on a faulty platform of fundamental movement. Regardless of how big, fast, or strong we are, we require a fundamental base of movement. With this fundamental base we can ensure that what we are gaining in strength and skill when we train can be maintained safely and efficiently. The cornerstone of this foundation is rooted in one simple movement – the squat.
It’s like building a house without a proper foundation. You could build a beautiful house that’s filled with expensive furnishings in each and every room. This house may even seem secure and sound from an outsider’s perspective. However, an inexperienced person with little knowledge on architecture can tell you the house built on a faulty base is set up for eventual failure. Proper functioning of our physical ‘house’ requires that we move first with movement competency before we perform.
Instead of adapting to our limitations or just ignoring them all together, its time to fix our movement issues. It’s time to shift our training efforts that have been focused on remodeling our physical ‘house’ without ever fixing the large crack in our home’s foundation. This starts with seeing the athlete in a different manner – through the looking glass of movement.
Until the next lecture,
- Prodromos CC, Han Y, Rogowski J, et al. A meta-analysis of the incidence of anterior cruiate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy. 2007 Dec. 23(12): 1320-1325.
- Krosshaug T, Nakamae A, Boden BP, et al. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J. Sports Med. 2007,35;359-366
- Boden BP, Dean GS, Feagin JA, et al. Mechanisms of anterior cruciate ligament injury. Orthopedics. 2000;23:573-578
- Kritz M, Cronin J, Hume P. (2009) The bodyweight squat: a movement screen for the squat pattern. NSCA. 31(1);76-85