Tuesday, 14 February 2017

'A'- Frame Skiers: Part 2

Before I start, I want to emphasise that there is no 'one size fits all' in terms of ways to help correct or improve an 'A'- Frame position. Every single person will have individual needs. However, the suggestions below have been collated from over a decade of working with skiers and identifying common movement patterns and compensations. This includes work analysing hundreds of instructors working their way through various stages of the BASI system and work alongside BASI trainers to ensure accuracy and carry over between off hill and on hill training.

These exercises can benefit anyone that struggles with an 'A'-Frame posture. They are not limited to ski instructors, but I hope that instructors will find the information useful from not just a personal perspective, but also a coaching perspective.  I also hope this information will be useful to anyone looking to improve their ski performance and hopefully technique.

This blog is designed to follow on from our last blog on 'why an 'A'-Frame position may occur', so we recommend that you read this prior to continuing below.  This was recently republished through our facebook page, or your can search the blogs from March 2016.

In terms of exercise prescription, as a general rule if it challenges you it is probably something that you need to work on.  It is not easy to recommend repetitions, weights and frequency of the exercises but as a general guide aim to practice the exercises that are relevant to you 3 times a week for a minimum of 6-8 weeks to make a difference.   The training over this time should also be progressive, so that the muscles are constantly being challenged as they develop.  The exercises should be made harder and challenge you further every 1-2 weeks.  A static program will not allow for continual progression and will soon become tiresome and uninspiring.

The exercises below are aimed at improving neural connections, movement patterns and endurance for skiing, rather than specifically for strength training.  With that in mind, you ideally want to perform the exercises into fatigue, taking care not to loose form and to ensure good quality of movement.  It is not as simple as saying how many times to perform each movement.  Every single person will be able to work at different levels and perform different numbers of repetitions, therefore assessment and progression by a physiotherapist or personal trainer is highly recommended.  The exercises below are a framework to start from and ideas to share with clients.  They should not be performed if they cause any pain and we recommend seeking medical advise if you have a pre-existing injury.

To re-emphasise, there is no overnight fix to correct an 'A'-Frame through exercises. It is likely to take a minimum of six weeks to start to notice changes when a progressive programme is carried out regularly, however we recommend at least 3 months of training to really make an impact.

Postural and position awareness


Did you know that only a very small proportion of people actually train to get fit to ski before a skiing holiday. Some of our data collection suggests that this figure may be as low as 4%! This figure applies to recreational skiers rather than instructors and professionals, however when I have been presenting to gap ski courses often less than 10% have done any ski specific fitness prior to starting their course!  Its no wonder we see so many ski related injuries on the slopes.

For those that do get fit to ski before coming away, how you train will greatly influence your movement patterns on the slopes.

Lets start with simply seeing if you are able to correct a knocked knee position. Stand in front of a mirror with your feet facing forward and ski width apart. Keep your back straight and squat down so your thighs are almost parallel with the floor. Repeat this a number of times whilst watching yourself in the mirror. Do your knees track nicely over your middle toes or do they come together?

Good alignment demonstrated.
Knees tracking nicely over
middle toes.  
Right knee falling into a
valgus 'knock-kneed' position
If they come together, are you able to correct it?  Can you maintain this corrected position as you repeat the movement?












This is often clearer to see on one leg. Repeat as above but this time perform a single leg squat (you won't necessarily be able to go so deep). Again, watch the position of your knee over your toes. Can you correct this simply through awareness and the feedback of watching yourself in the mirror? Repeat this for at least 60 seconds to see if you can maintain the position, even as you fatigue. We don't usually learn a lot through just one repetition. Movement faults are easier to identify as muscles start to tire.

    

If you are able to correct this, practice and regular repetition will help the body make neural adaptations which will improve coordination and proprioception. Proprioception is a term which describes the unconscious knowledge of the position of our body and limbs. Research has shown that proprioceptive control in a single leg stance may be a key factor in reducing injuries.

To challenge your position sense further, stand on an unstable surface such as a bosu ball and repeat the single leg squats. Maintain optimal knee position through out.




Weak hip abductors and external rotators 

As well as abducting the leg (pulling it in a sideways motion), one of the main roles of the gluteus medius is to stabilise the pelvis. As mentioned last week, a weak gluteus medius can cause the pelvis to drop on the opposite side. At times, people may also attempt to compensate for this on their supporting limb by rotating it inwards and allowing the thigh to draw across the body. Both these actions can result in a 'A'-frame ski position.

The exercises below will start to give you some ideas of how to improve the function of the gluteus medius muscle:

1 - Hip hitch

This is a good starting point for activating the gluteus medius and improving neural connections between the body and the brain.  Stand sideways on a step with one leg free over the edge. Keep your shoulders level and slowly drop and raise your free leg. To increase the difficulty you can add ankle weights.

               

2 - Side planks

Side planks are a great core stability exercise and also a great way to engage the gluteals. Gradually build up how long you can hold a plank position, aiming for 30 - 60 seconds and repeat this 3 - 5 times.
Short lever
Long lever












3 - Monster walk

Place a piece of theraband around your lower legs and stand in a long corridor. Squat down with a neutral back and look forward. Keep your stance wide and maintain good tension on the band. Side step keeping your knees bent and feet wide apart. The deeper the squat, the harder the challenge.

Make sure that your knees are always well aligned over your toes and feet are pointing forward. If your glutes are very weak, the knees tend to buckle in to compensate. Don’t let them!



4 - Hip rotations with theraband resistance

Hook a piece of theraband around one ankle and stand on the other end.  Draw your foot up your shin then turn your knee out. Your pelvis should stay facing forwards, whilst your knee lifts and you twist from the hip. This works your gluteals as well as challenging your balance, engaging your core helps with hip and pelvis dissociation. 

                                     


Tight ITB (iliotibial band)

If you have a tight ITB, it may well contribute to internally rotating your thigh (turning it inwards). As I mentioned in last weeks blog, if you have a weak gluteus medius muscle, this will often be coupled with a tight ITB, therefore one of the first steps I would take in an assessment of the ITB would be to also assess the gluteus medius muscle. If strength or endurance issues were highlighted, I would initiate a hip and gluteal muscle program as above.

I would also recommend foam rolling to help improve the fascial matrix of the ITB.  There are all sorts of foam rollers on the market, but the ITB can be a highly sensitive area, therefore we recommend a standard foam roller to start with. Place the roller under your thigh, as in the picture below. I usually divide my thigh into upper, mid and lower portions and then lever myself back and forth for as long as I can tolerate.

How long should you roll for? Initially I recommend 10 - 20 seconds if it feels very sore but build up to 2 mins of rolling the length of the ITB over a period of 4 - 6 weeks. A good time to roll is after skiing.


                                      

Foot over-pronation

The foot needs a certain amount of pronation to function effectively, however over pronation can often be (not always) more problematic. The feet are highly complex structures and I do recommend seeking professional opinion if you feel that over pronation may be contributing to an 'A'-Frame position.

As I mentioned last week, working out why the over pronation is occurring is key to applying the correct treatment. As a physiotherapist, I aim to work out if there is structural or functional cause of over pronation (or a combination of both). If the problem is structural, it is not likely to change with exercises, however more often that not there is a functional cause or contribution e.g. the muscles, fascia and other soft tissue structures are not doing their job properly! How do you know if your problem is structural or functional? Well, you probably won't without the professional opinion of a physiotherapist, podiatrist or highly trained boot fitter.

A recent study (Hashimoto and Sakuraba, 2014) looked at strength training for the intrinsic flexor muscles of the foot and found a positive effect on muscle strength, the foot arch and dynamic parameters. They concluded that intrinsic foot flexor strength training is useful for improving standing and walking performance, in addition to improving the performance of sports athletes engaged in activities involving greater exercise loads.

This research is just one study in a large body of evidence which adds support my anecdotal findings. If the problem is down to muscle imbalances, the exercises below can be introduced as part of a training program. I would also include gluteus medius work, as shown in the section above. As I mentioned before, these exercises must be performed regularly and be progressive in nature. If its not challenging you, you will not continue to make progress.


1 - Supination Exercises

Wear sock on a shiny surface. Transfer your weight more towards the outer edge of your foot and work the muscles under the arch of your foot.

When you can maintain this position for periods of time, you can also try to maintain it during more functional training such as squats, heel raises and lunges.


The movement is not well demonstrated in these pictures, but if you look closely you will see that in the first picture, the foot is rolling in. The inside ankle bone is more prominent.  This has then been corrected into a 'neutral' stance in the second picture.

2 - Towel folding

This exercise aims to strengthen the plantar fascia and deep intrinsic muscles of the foot.  Stand with a towel laid out on the floor in front of you. Grasp one corner with your toes (not inbetween your toes - thats cheating, aim to scrunch up your toes so the towel is held in between your toes and the pad of your forefoot).  Fold the corner of the towel into the middle, and repeat with the other three corners. Then using the same action, unfold each corner again. Compare one foot to the other. If you find it easy, your probably don't need to practice it.  



3 - Calf raises

Stand on a step. Rise up onto the ball of your toes, pause and then slowly sink your heels down.  You can aim to perform 3 sets of 15 repetitions.  If this is easy, try the same exercise on one leg.

To progress even further, wear a rucksack on your back and add hand weights or bottles of water to increase the resistance and the load on the muscles.   It is important that you perform this slowly and allow yourself to go up and down to the limit of your range.



4 -Big Toe Pushdowns

Stand with your foot and ankle in neutral position. Push down through your big toe without allowing the ankle to roll in or the arch to collapse. Start by holding that for 5 seconds, 10 times on each side (or do both sides at once). As you get stronger, hold the toe down for longer stretches and fewer repetitions. You’ll start to feel that muscle (flexor hallicus) contract under the arch of the foot. As it gets stronger, you’ll be able to consciously engage that muscle whenever you’re performing weight bearing exercise.

5 - Eversion on a Step

This exercise helps to target the tibialis posterior muscle, which amongst other roles helps to support the medial arch of the foot.  Stand sideways on a step so that the inside of the foot is just over the edge.  Very slowly roll the arch of the foot inwards, as if trying to get the big toe down to the floor
Reverse the movement to bring you back up to the starting position. As with the calf raises above, aim for 3 sets of 15 repetitions and if easy, use a weighted rucksack to increase the resistance.



6 - Run around a lawn barefoot

This exercise is as it says on the box.  Let the small muscles of the foot work hard to stabilise the foot and ankle complex over uneven ground.  Lose the support of shoes for a while and allow the muscles to do their job.

Orthotics

Often, a progressive program to correct muscle imbalances in the lower limbs is sufficient, other times orthotics or foot beds are necessary.

Colin Martin, a certified podorthotist based at Solutions 4 Feet in Bicester www.solutions4feet.com was kind enough to contribute the following:

'From a boot fitters perspective we try first to stabilise the foot, then to look at what else is going on, often the client can do exercises to strengthen muscles and get a more neutral stance, other times the natural body shape simply does not allow this to happen, it is then were we can intervene using the cuff adjustment ( often called canting) of the boot. Or but working under the sole of the boot using many methods of TRUE canting to get the best result. SOME PEOPLE ARE NOT CANTABLE sometimes you have to settle for skis flat on the snow and a bow legged or knock kneed stance, other people are lucky and can have perfectly parallel shins AND skis running flat.

Trouble is people want an instant fix and many will not do the exercises so try to insist on fixing the problem using canting, my job is to find the right balance for each individual to give them the best skiing experience'


Hip Joint

As I mentioned last week, occasionally, an 'A'-frame skier may not be able to correct their position because the cause is inherent within the ball and socket joint of the hip. I was recently asked what the best thing to do in this case was. This is a tricky question to answer because everyone is individual with different needs. If it's truly an issue with the hip joint, exercises are less likely to help, although often the body does have ways of developing compensation strategies over time, even if an 'A'-frame position can't be completely corrected. For example, people with congenital hip problems (from birth) that haven't needed orthopaedic input are likely to have compensations further down the chain, such as increased external rotation through their tibias. Seeing a good boot fitter or alignment specialist may also be of benefit.

Osteoarthritis and Rheumatoid arthritis of the Knee Joint

If the inner aspect of your knee has been affect by arthritis, it will probably be a structural problem that is causing an 'A'-Frame.  However, I would still implement some of the training above, starting with seeing if you can correct the position in front of a mirror and improve proprioception of the knee joint.  The majority of the time, people with arthritic knees can also benefit from training the hip and gluteal muscles as above.  I would also recommend discussing orthotics, wedges and canting options with an experienced boot fitter, preferably one that has an understanding of arthritic pathology.  


Disclaimer:

We do not recommend that you introduce these exercises without consulting a physiotherapist if you have any current injuries or back issues. We do recommend seeking advise from a healthcare or fitness professional when starting new exercises.

The purpose of this blog, is to provide general information and educational material relating to physiotherapy and injury management. Bonne Santé physiotherapy has made every effort to provide you with correct, up-to-date information. In using this blog, you agree that information is provided 'as is, as available', without warranty and that you use the information at your own risk. We recommend that you seek advise from a fitness or healthcare professional if you require further advice relating to exercise or medical issues.



References;

Proprioceptive Training and Injury Prevention in a Professional Men's Basketball Team: A Six-Year Prospective Study. Journal of Strength & Conditioning Research: February 2016 - Volume 30 - Issue 2 - p 461–475 Riva, Dario; Bianchi, Roberto; Rocca, Flavio; Mamo, Carlo

Strength Training for the Intrinsic Flexor Muscles of the Foot: Effects on Muscle Strength, the Foot Arch, and Dynamic Parameters Before and After the Training. J Phys Ther Sci. 2014 Mar; 26(3): 373–376. Takayuki Hashimoto and Keishoku Sakuraba

LSA
       Bonne Santé          info@bonnesantephysio.com         0033 (0) 4 79 06 07 27

Please like us on Facebook to stay up to date with news and developments: Bonne Santé Physiotherapy 
Follow us on instagram: Bonne_Sante_Physiotherapy
Follow us on twitter: @valdiserephysio

7 comments:

  1. If you want to get the best physiotherapy centre from where you can get the treatment for your joints at very reasonable cost then you can go with NK Aggarwal Joints and Spine centre. This treatment can give you the long term benefit with and you can get rid of severe pain.

    ReplyDelete
  2. This comment has been removed by the author.

    ReplyDelete
  3. Nice Blog

    Fitness & Rehab clinic is for Physiotherapy. The clinic is run by Mr. Earnest Vijay, a Sports Physiotherapist. The clinic is Located in Chennai, India

    Physiotherapy in Chennai
    Physiotherapist in Mylapore
    Orthopedic Physiotherapy in Chennai

    ReplyDelete
  4. Thanks for sharing this helpful Physiotherapy Exercises to improve the function of the gluteus medius muscle. Physiotherapy Treatment in Mumbai can also help you to get rid of your pain.

    ReplyDelete
  5. good information in this blog prove and Postural and position awareness is very good info

    best physiotherapy service at home

    ReplyDelete
  6. Indian Chat Rooms its a amzaing and full of fun post i like it.


    great post i like it Pakistani Chat Rooms you can join it free.



    Adult Live Chat room join me there for live cam chat.


    Teen Chats Rooms wawoooo how is nice post this one i like it. you can join it free.



    Indian Fashion wawoooo how is nice post this one i like it. you can join it free.

    Linuxmind1


    Indian Chat Room join us its free cam chat amazaing i like it.



    PAKISTANI ONLINE CHATROOMS join us its free cam chat amazaing i like it.


    INDIAN CHATROOMS wawoooo how is nice post this one i like it. you can join it free.


    MOBILE CHAT ROOMS its a amzaing and full of fun post i like it.



    Sex Chat Rooms its a amzaing and full of fun post i like it.

    ReplyDelete