Notes - ITCCCA

Injury Prevention
Getting it right before the season starts
Nate Porcher DC ART DNS FMS
Copyright Dr. Nate Porcher
Quickly About Me
Prospect HS Alum
Taylor University in Indiana – Track and FB Letterman
Trinity International University in Deerfield – FB and Baseball
National University of Health Sciences –Doctor of Chiropractic
Hundreds of hours of postgraduate training in Functional Evaluation,
Rehabilitation, Soft Tissue Correction, Strength and Conditioning
Spent some time working in the training room with athletes at
Benedictine University in Lisle
Sports Medicine-Focused practice in downtown Arlington Heights—
Foundation Sport & Spine
Copyright Dr. Nate Porcher
Topics Covered
 Common Injuries—why they occur
 Prevention of Injuries
 The Role of the Diaphragm in Core Stability
 Tri-planar Training for Sagittal Plane Athletes
 The Benefits of having a sports healthcare practitioner
as part of your team—PRESEASON SCREENING,
management of injuries that have occurred
Copyright Dr. Nate Porcher
How often do injuries
 The most common running injuries
 Shin splints/stress fractures
 Hamstring or other muscle pulls/tears
 Plantar fasciitis/Heel pain
 Patellar Tendonitis/knee pain
 IT Band Syndrome
 Low back stiffness/pain
 What other injuries plague your program?
Copyright Dr. Nate Porcher
What are your current methods of
Injury Prevention?
 How have these reduced soft-tissue injuries?
 Once injuries occur, how are you managing them?
Copyright Dr. Nate Porcher
Main cause of most of these injuries
In General: OVERUSE (of a bad motor strategy)
In Particular:
IT Band Syndrome—weak core/glutes
Shin Splits—more complex (will cover in depth later)
Patellar tendonitis—weak glutes, poor core/pelvic stability, weak
tibialis anterior, and dominant quads/hip flexors
Plantar Fasciitis—weak foot intrinsics, weak tibialis anterior,
poor hip extension
Low Back Pain—weak core/glutes/improper motor patterns
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The “Intangibles”
 Anatomy Fallen Arch, hip anteversion, integrity of
connective tissue in the body, etc, etc.
 Body Chemistry/Nutritional Status
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Re-Envisioning the CORE
Copyright Dr. Nate Porcher
The Role of The Diaphragm
 Is it just for breathing?
 Let’s take a closer look
at the design of the
 In my clinic—
diaphragm function
tested on day one, and
diaphragm rehab starts
day one.
Copyright Dr. Nate Porcher
One muscle, two amazing
 Breathing function
 Postural function
Diaphragm contracts/
Decreased pressure in
thoracic cavity
Pelvic Floor contracts,
Air rushes in
O2/CO2 exchange
Abdominal muscles
reflexively contract
(TrA, Obliques, QL,
rectus abdominus
Diaphragm relaxes
Elasticity of ribs and
lung tissue forces air out
pressure increases
Punctum fixum is
Copyright Dr. Nate Porcher
Creating the Punctum
 What’s the big deal? Why the diaphragm?
 Punctum Fixum – FIXED POINT
 i.e. intra-abdominal pressure stabilizes the anterior hip
capsulethe glute medius attaches to the hip and
pelvisstable hip increases glute med firing/stabilability
 i.e intra-abdominal pressure stiffens the abdominal
fascia, T/L fascia, and stabilizes the rib cagecreates a
solid basis for the obliques to pull up and over
 Need an example?
Copyright Dr. Nate Porcher
The role of the ribcage
position over the pelvis
 Intra-abdominal
pressure is
compromised by poor
 This will cause buckling
of the lumbar spine and
poor core stability, poor
base for oblique systems
Copyright Dr. Nate Porcher
How do you know it’s
not working
How do you know it’s
not working?
 Here are a couple of tests:
 Diaphragm Test with Breathing IN
Copyright Dr. Nate Porcher
Another test
Copyright Dr. Nate Porcher
One more test
 Intra-Abdominal Pressure (IAP) Test
Copyright Dr. Nate Porcher
How to destabilize the
 Situps, Crunches, V-ups, supine toe-touches
 “The spine only has so many bends before a disc will
herniate.” Stu McGill –University of Waterloo
 3,350 Newtons of compressive force in the disc with them
Copyright Dr. Nate Porcher
Some basic exercises for
stabilizing the core
 Use (some of the tests) as the exercises
 Have athletes gain awareness/ability to use the
diaphragm first as a muscle of respiration
 Have them start to gain awareness/ability of the
postural/stabilization function
 Side bridge/plank progression
 4-way bench planks
 Supine IAP test in Triple Flexion (knees, hips, and
ankles at 90 degrees
 Can add physioball as an advancement
Copyright Dr. Nate Porcher
More Exercises
 Bird Dogs– must maintain proper stabilization
strategy of core and KEEP BREATHING.
Complex exercises
Variations of Side Planks
(remembering to have intraabdominal pressure)
Once the Core is Solid
 Implementing the role of the oblique muscle slings
 Dynamic movements using the slings to move
 Chops, Lawnmowers (for power)
 i.e. throws, running, etc.
 Dynamic movements using the slings to stabilize
 i.e. throws, running, etc.
Copyright Dr. Nate Porcher
Continuing Onto Global
 This idea of increasing abdominal pressure NEVER
GOES AWAY with any exercise!
 Guess why these guys wear belts when lifting?
Triplanar Training for the
(primarily) Sagittal Plane
Copyright Dr. Nate Porcher
What exactly does that
 Review of Planes of Movement
 Sagittal
 Coronal/Frontal
 Transverse
Examples of Poor
Another Example
Another Example!
Combined Frontal/Transverse
Plane Instability
Contrasting Those Examples With
Olympic Athletes
Two Bads and One Good
Making Basic Lifts Tri-planar
 Sometimes with movement, sometimes with stability
 Use Dumbells or (better yet), Kettelbells
 Squats
 Goblet, 90, Overhead
 Lunge. 90, overhead
 Single-Leg RDL
Copyright Dr. Nate Porcher
Making it even better with
 Lunges, step-downs with Therabands®
 Tri-Planar Squats (from the last few slides)
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Tri-Planar Plyos
 Jumping Lunges
 Tri-Planar Box Jumps
 Burn-outs
Copyright Dr. Nate Porcher
Dr. Nate Porcher DC ART DNS FMS
Why do all my athletes have
shin splits?
 Medial Tibial Stress Syndrome:
 1st things 1st—Rule out Stress Fracture/Compartment
 2nd—Understand the tissue pathology
 3rd—Determine the appropriate course of action
 4th—Implement the appropriate course of action
Copyright Dr. Nate Porcher
RSI of soft tissues in general
and shin splints in particular 
 RSI—Repetative Strain Injury
Copyright Dr. Nate Porcher
What’s the latest Research Say?
Bennet et. al. The relationship between isotonic plantarflexor endurance,
navicular drop, and exercise-related leg pain in a cohort of college crosscountry runners. International J Sports Phys Ther. 2012 Jun; 7(3): 267-78.
Greater Navicular drop tend to have greater chance of leg pain
History of shin splints in last month 12X more likely to re-develop
In other words...
Yuksel et. al. Inversion/Eversion Strength Dysbalance in Patients with
Medial Tibial Stress Synrome. J Sports Sci Med. 2011 Dec; 10(4): 737-42.
Prolonged pronation will lead to longer lasting traction stress on the soleus fascia, which
in turn can facilitate the development of MTSS (all due to stronger evertor muscles)
Also, likely due to less eccentric power/strength/endurance of the medial soleus
Rathleff et. al. Dynamic midfoot kinematics in subjects with medial tibial
stress syndrome. J Am Podiatr Med Assoc. 2012 May-Jun; 102(3): 205-212.
More navicular drop, faster navicular drop
Copyright Dr. Nate Porcher
My thoughts...
If they need orthotics—send them, this will help with navicular drop velocity
and depth.
Still—orthotics are not the final solution, but one piece in the puzzle!
Should be combined with “short foot” training, coronal plane glute med training
=less contralateral hip drop, less internal rotation lower leg, less pronation of the
Isokinetic strength does not equal plyometric power.
Eccentric strength of the lower shank external rotators (i.e. GLUTE
MED/MIN) is a driving force behind decreasing overpronation in the foot.
Exercises that get the soleus to adapt rapidly from an eccentric muscle to a
concentric one should be implemented (plyos, blind box drops, tri-planar
Correct tissue pathology, because ice, rest does not heal fibrotic, tight, painful
scar tissue. Send them for this too!
Copyright Dr. Nate Porcher
How to I break the cycle?
 Break up the adhesions:
 Best two ways: ART® (Active Release Techniques®),
and FAKTR® (Functional and Kinetic Treatment w/
 Correct joint restrictions to proper biomechanics
 Subtalar eversion restoration
 SI joint mobilization (if it’s no moving, the glute med
won’t fire properly!!)
Copyright Dr. Nate Porcher
How do I break the cycle?
Dampen the inflammatory cascade:
With proper nutrition (Diet high in Omega-3 FA, avoidance of
high Omega-6 foods)
The short foot muscles (dampen forces through the ML arch
and T Arch)
The G Meds/Mins to dampen internal rotation forces
experienced from ground reaction forces.
Plyo/reaction strength/power of Gasroc/Soleus mm.
Any other multiplanar instabilities with tri-planar training.
Use Corrective Taping, when warranted
KinesioTex Tape—change muscle firing, help drain.
Copyright Dr. Nate Porcher
Pre-Season Functional
Movement Screening
 Gray Cook—The guy behind the FMS™ screens
 “What often happens is people are putting exercise and
performance on top of dysfunctional movement, which
can impair performance and cause injuries”
Copyright Dr. Nate Porcher
Who should get screened?
 All athletes who are pain-free, and wanting to perform
at a high level. (Sound familiar?)
 WHY?
 The screens identify imbalances side to side
 The screens identify the weak link in the chain
 The screens point to corrective exercise strategies to help
optimize later training and prevent injury
 (The athlete who experiences pain with the screen should
be referred to a healthcare provider)
 The screen should always be used as a follow-up tool to
monitor progress
Copyright Dr. Nate Porcher
How to implement the
Pre-season screening by certified FMS practitioner
 Develop categories for athletes with different types of
dysfunction to fit into
 Develop programs for those athletes--add it into their
resistance program
 Be judicious about what full-body lifts to use with athletes
who have poor dynamic function, ease them into them
once base function is corrected/core is strengthened
 When an athlete has pain—send them for professional eval
Don’t let the injury progress to a season-ending situation!
Copyright Dr. Nate Porcher
Thank you!
Copyright Dr. Nate Porcher
Image Resources
Title page:
Diaphragm diagram:
Diaphragm diagram 2:
Turtle Shell 6 pack:
Westside Barbell:
Diaphragm tests: All copyright Prague School
Shin splits:
Copyright Dr. Nate Porcher
How to reach me:
 Nate Porcher DC ART DNS FMS
Email: [email protected]
Office: (847) 342-3000
115 N. Arlington Heights Road
Suite 104
Arlington Heights, IL 60004
Copyright Dr. Nate Porcher

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