ACL Injury Prevention · 2019-07-09 · Objectives • Brief history ACL Injury – who, what,...

ACL Injury PreventionACL Injury Prevention

Poetry In MotionPoetry In Motion

To BE or not to beTo BE or not to be

ObjectivesObjectives•• BriefBrief history ACL Injuryhistory ACL Injury

–– who, what, where who, what, where –– when, how, whywhen, how, why

•• BriefBrief summary Protocol Based Injury summary Protocol Based Injury Prevention ProgramsPrevention Programs–– why: what the research foundwhy: what the research found–– who: programswho: programs

•• Presentation of a NonPresentation of a Non--Protocol Based Protocol Based FundamentalFundamental ApproachApproach–– SMASMA33RT TrainingRT Training–– Flow Training PrinciplesFlow Training Principles–– Pose Method RunningPose Method Running

Who, where, whenWho, where, when

•• AthleteAthlete–– MaleMale–– Professional/collegiateProfessional/collegiate–– Contact > nonContact > non--contactcontact

•• AthleteAthlete–– High SchoolHigh School–– Males & femalesMales & females–– NonNon--contact > contactcontact > contact

•• AthleteAthlete–– HS & belowHS & below–– ^ incidence females (all levels)^ incidence females (all levels)–– NonNon--contact >> contactcontact >> contact

ACL ACL “Allure”“Allure”

•• Joe NamathJoe Namath–– very high profilevery high profile–– multiple knee injuries multiple knee injuries

bilaterallybilaterally–– groundbreaking groundbreaking

interventionintervention•• SurgerySurgery•• RehabilitationRehabilitation•• bracingbracing

Joe’s ContributionJoe’s Contribution

•• Realization of the costs of Realization of the costs of ACL injuryACL injury–– Time from playTime from play–– $$

•• Recognition that ACL Recognition that ACL injuries need not be injuries need not be career endingcareer ending

•• Advancements in surgical, Advancements in surgical, rehabilitative and bracing rehabilitative and bracing technologiestechnologies

•• And…And…

liberation from conservative fashion paradigmsliberation from conservative fashion paradigms

But not everyone can be a SuperheroBut not everyone can be a Superhero

What: hurt, damage, lossWhat: hurt, damage, loss

•• in·ju·ry in·ju·ry n.n. pl.pl. in·ju·ries in·ju·ries 1. 1. Damage or harm done to or suffered by a Damage or harm done to or suffered by a

person or thingperson or thing2. 2. A particular form of A particular form of hurt, damage, or losshurt, damage, or loss: :

a leg injury. a leg injury. 3.3. approximately 1750 Newtons or moreapproximately 1750 Newtons or more

anterior cruciate ligament anterior cruciate ligament Cross, M.J. 1998 Encyclopedia of Sports Medicine and ScienceCross, M.J. 1998 Encyclopedia of Sports Medicine and Science

•• The ACL is a The ACL is a broad ligamentbroad ligament joining the anterior tibial plateau to the joining the anterior tibial plateau to the posterior femoral intercondylar notch. The tibial attachment is posterior femoral intercondylar notch. The tibial attachment is to a facet, in to a facet, in front of, and lateral to the anterior tibial spine. The femoral front of, and lateral to the anterior tibial spine. The femoral attachment is attachment is high on the posterior aspect of the lateral wall of the interconhigh on the posterior aspect of the lateral wall of the intercondylar notch.dylar notch.

•• It is composed of multiple nonIt is composed of multiple non--parallel fibers, which, though not parallel fibers, which, though not anatomically separate, act as anatomically separate, act as three functionally distinct bundlesthree functionally distinct bundles i.e. i.e. anteromedial, posterolateral and intermediate. Owing to their wianteromedial, posterolateral and intermediate. Owing to their wide de attachments, variable fiber lengths and the rotation of the ACL attachments, variable fiber lengths and the rotation of the ACL that that accompanies flexion, the tension in each bundle varies throughouaccompanies flexion, the tension in each bundle varies throughout the t the range of motion.range of motion.

•• The biomechanical function of the ACL is complex for it providesThe biomechanical function of the ACL is complex for it provides both both mechanical stability and proprioceptive feedbackmechanical stability and proprioceptive feedback to the knee. In its to the knee. In its stabilizing role it has four (main) functions:stabilizing role it has four (main) functions:–– Restrains anterior translationRestrains anterior translation of the tibia; of the tibia; –– Prevents hyperextension of the knee; Prevents hyperextension of the knee; –– Acts as a secondary stabilizer to valgus stress, reinforcing theActs as a secondary stabilizer to valgus stress, reinforcing the medial collateral medial collateral

ligament; and ligament; and –– Controls rotation of the tibia on the femur in femoral extensionControls rotation of the tibia on the femur in femoral extensions of 0s of 0--30°. 30°.

•• This final role is the main clinical function of the ACL. ACL deThis final role is the main clinical function of the ACL. ACL deficiency causes ficiency causes failure of this screwfailure of this screw--home mechanism, resulting in subluxation of the tibia home mechanism, resulting in subluxation of the tibia on the femur. This critical function in the range of 0 on the femur. This critical function in the range of 0 -- 30° is important for 30° is important for movements such a sidemovements such a side--stepping and pivoting. stepping and pivoting.

HowHow

•• Contact or NonContact or Non--contactcontact•• Pivot Pivot –– planting and cuttingplanting and cutting

–– IR varusIR varus–– ER valgusER valgus

•• Hyperextension Hyperextension –– straightstraight--knee landingknee landing•• Hyperflexion Hyperflexion -- gangtacklegangtackle•• Quadriceps Contraction Quadriceps Contraction -- pivoting and sudden pivoting and sudden

decelerationdeceleration•• Combinations Combinations -- oneone--stopstop--landing in extension landing in extension

ContactContact

ER valgusER valgus

Pivot Pivot –– cut, varuscut, varus

Why: Proposed CausesWhy: Proposed Causes•• EnvironmentalEnvironmental

–– Playing surface conditionPlaying surface condition–– Footware Footware

•• AnatomicAnatomic–– ACL agenesisACL agenesis–– Intercondylar notch sizeIntercondylar notch size–– LowerLower--leg alignmentleg alignment–– Knee joint laxity/genu recurvatumKnee joint laxity/genu recurvatum–– Muscle flexibility Muscle flexibility –– Ligament dominanceLigament dominance–– Increased Q angle/tight ITBIncreased Q angle/tight ITB–– Pes planusPes planus

•• PhysiologicPhysiologic–– High quad to ham ratio/neuromusclar imbalanceHigh quad to ham ratio/neuromusclar imbalance–– Poor biomechanics/motor executionPoor biomechanics/motor execution–– Hormones Hormones –– Existing injury/pain (especially hams)Existing injury/pain (especially hams)–– Protective reflex response (active extension particularly)Protective reflex response (active extension particularly)

•• PsychologicalPsychological–– Previous or recently recovered injuryPrevious or recently recovered injury–– General lack of confidenceGeneral lack of confidence–– Reckless or timid playing styleReckless or timid playing style

WhatWhat

DODO

We Do?We Do?

PreventionPrevention

•• pre·vent pre·vent v.v. pre·vent·edpre·vent·ed, , pre·vent·ingpre·vent·ing, , pre·ventspre·ventsv.tr.v.tr.1. 1. To keep from happening: took steps to prevent the To keep from happening: took steps to prevent the

strike.strike.2. 2. To keep (someone) from doing something; impede: To keep (someone) from doing something; impede:

prevented us from winning.prevented us from winning.3. 3. ArchaicArchaic To To anticipateanticipate or counter in or counter in advanceadvance..4. 4. ArchaicArchaic To To prepareprepare for; precede.for; precede.

BiomechanicsBiomechanicsJune 2005June 2005

Dynamic BalanceDynamic BalanceBy: Timothy E. Hewett, PhD, Gregory D. By: Timothy E. Hewett, PhD, Gregory D.

Myer, and Kevin R. Ford Myer, and Kevin R. Ford

If preventive modalities such as dynamic neuromuscular If preventive modalities such as dynamic neuromuscular training can reduce the incidence of knee injury by even a training can reduce the incidence of knee injury by even a few percentage points, thousands of knee injuries can be few percentage points, thousands of knee injuries can be prevented in high school and collegiate sports annually. In prevented in high school and collegiate sports annually. In addition, with the everaddition, with the ever--increasing popularity of highincreasing popularity of high--risk risk jumping and pivoting sports like soccer, volleyball, and jumping and pivoting sports like soccer, volleyball, and

basketball and the rapidly growing number of participants basketball and the rapidly growing number of participants each year, even higher numbers of injuries could be each year, even higher numbers of injuries could be

avoided in the future.avoided in the future.

Some NumbersSome Numbers

•• 250,000 annual injuries250,000 annual injuries–– 1 in 3000 general population1 in 3000 general population–– 2 2 –– 8x greater incidence in females 158x greater incidence in females 15--25yo25yo

•• $1.5 billion annual cost in surgeries$1.5 billion annual cost in surgeries–– Excludes pre/post op interventionExcludes pre/post op intervention–– Excludes nonExcludes non--op sprainsop sprains

•• Loss of TimeLoss of Time–– 1 full season1 full season–– 4 to 6 months recovery4 to 6 months recovery–– 250 hours rehab250 hours rehab

Evolution Prevention ProgramsEvolution Prevention Programs•• Chuck Henning, MDChuck Henning, MD•• Timothy Hewett: biomechanist Timothy Hewett: biomechanist

(Sportsmetrics: CSM)(Sportsmetrics: CSM)•• Vermont Safety Research GroupVermont Safety Research Group•• Hunter Valley Conference on ACL Hunter Valley Conference on ACL

Prevention StrategiesPrevention Strategies•• Santa Monica OSMGSanta Monica OSMG•• Dynamic neuromuscular training analysis Dynamic neuromuscular training analysis

(Myer, Ford, Hewett: CSM)(Myer, Ford, Hewett: CSM)

Chuck Henning, MDChuck Henning, MD

•• Viewed video female athletesViewed video female athletes•• "quad"quad--cruciate interaction“cruciate interaction“

–– Knees extendedKnees extended–– Quad force ^ stress ACL Quad force ^ stress ACL

•• Landing, cutting, pivoting, and stopping Landing, cutting, pivoting, and stopping with flexed knees & hips with flexed knees & hips

•• Reported reduction injury ratesReported reduction injury rates

Timothy Hewett: biomechanist Timothy Hewett: biomechanist Cincinnati Sports Medicine Cincinnati Sports Medicine

SportsmetricsSportsmetrics

•• Plyo drills emphasizing landing BOF/HKF/BBLEs Plyo drills emphasizing landing BOF/HKF/BBLEs –– postureposture–– stabilitystability–– soft landingsoft landing–– verbal cuesverbal cues

•• StretchingStretching•• StrengtheningStrengthening

Vermont Safety Research GroupVermont Safety Research Group

•• Awareness hazardous situationsAwareness hazardous situations•• PrePre--planning strategiesplanning strategies

Hunter Valley Conference on ACL Hunter Valley Conference on ACL Prevention StrategiesPrevention Strategies

•• MultidisciplinaryMultidisciplinary

•• Acknowledged success of research and Acknowledged success of research and previously implemented programspreviously implemented programs

–– Caraffa et al : sevenfold reductionCaraffa et al : sevenfold reduction

–– Vermont Ski Safety: 69% reductionVermont Ski Safety: 69% reduction

–– Hewett: 3.6x reduction trained vs. untrainedHewett: 3.6x reduction trained vs. untrained

Santa Monica OSMGSanta Monica OSMGPEP programPEP program

•• Sport specific (soccer)Sport specific (soccer)•• On field, preOn field, pre--practice/gamepractice/game

–– Warm upWarm up–– StretchingStretching–– StrengtheningStrengthening–– PlyometricsPlyometrics–– Agilities Agilities

•• Nationally implemented, research directedNationally implemented, research directed•• Video Video

Dynamic neuromuscular training Dynamic neuromuscular training analysis (Myer, Ford, Hewett)analysis (Myer, Ford, Hewett)

•• DominanceDominance--based Programbased Program–– Assessment basedAssessment based

•• 33--D digital videographic kinematic analysisD digital videographic kinematic analysis•• Isokinetic testingIsokinetic testing

–– Individually designedIndividually designed–– NonNon--protocol interventionprotocol intervention

•• Dominance (in females)Dominance (in females)–– Ligament dominance Ligament dominance

•• Andrews and Axe Andrews and Axe •• Allow GRF to be absorbed by ligaments vs. musclesAllow GRF to be absorbed by ligaments vs. muscles•• LE valgus/^GRF/high torque @ kneeLE valgus/^GRF/high torque @ knee

–– Leg dominanceLeg dominance•• Strength R vs. L Strength R vs. L •• Coordination r vs. LCoordination r vs. L

–– Quadriceps dominanceQuadriceps dominance•• Hams to quad ratio 66%Hams to quad ratio 66%•• = bilaterally= bilaterally

Athletic positionAthletic position

Wall jumpsWall jumps

Tuck JumpsTuck Jumps

Broad jump and holdBroad jump and hold

180 jump180 jump

SingleSingle--leg hop & holdleg hop & hold

Squat jumpsSquat jumps

X jumpsX jumps

SingleSingle--leg balanceleg balance

Jump, jump, jump, vertical jumpJump, jump, jump, vertical jump

BoundingBounding

Common Goals of Prevention Common Goals of Prevention ProgramsPrograms

•• Avoid vulnerable positionsAvoid vulnerable positions•• Improve flexibility & strength Improve flexibility & strength •• Maximize proprioception & kinesthesia Maximize proprioception & kinesthesia

through dynamic activitiesthrough dynamic activities•• Enhance Enhance neuromotorneuromotor performanceperformance

Tools of Prevention ProgramsTools of Prevention Programs

•• LiteratureLiterature•• CoursesCourses•• Internet Internet •• DVD/video tapeDVD/video tape

*present information to/through athletic trainers, *present information to/through athletic trainers, coaches, physical therapists to athletescoaches, physical therapists to athletes

*stress technique with verbal cues reinforcement*stress technique with verbal cues reinforcement

Prevention ProgramsPrevention Programs•• Proactive interventionProactive intervention

–– EducatesEducates–– ConditionCondition

•• PhysicallyPhysically•• PsychologicallyPsychologically

•• Protocol basedProtocol based–– Common factorsCommon factors–– Primarily femalePrimarily female–– Implemented year roundImplemented year round–– Broad usefulnessBroad usefulness

•• SMARTSMART

SMASMA33RT TrainingRT Training•• SystematicSystematic

–– PurposefulPurposeful–– Schedule or regimenSchedule or regimen–– Proper equipmentProper equipment–– Appropriate nutritionAppropriate nutrition–– AA33RTRT

•• MixedMixed–– Variety training modalitiesVariety training modalities–– Maximize interestMaximize interest–– Enhance all body systems: nms, cr, lymph, etc…Enhance all body systems: nms, cr, lymph, etc…

•• Aerobic, Anaerobic, AgilityAerobic, Anaerobic, Agility•• Rest, RecoveryRest, Recovery

–– MicroMicro–– macromacro

•• TechniqueTechnique–– DefineDefine -- CommunicateCommunicate–– DescribeDescribe -- EvaluateEvaluate–– DemonstrateDemonstrate -- EmancipateEmancipate

Technique = Teach, Teach, TeachTechnique = Teach, Teach, Teach

•• DefineDefine•• DescribeDescribe•• DemonstrateDemonstrate

•• CommunicateCommunicate•• EvaluateEvaluate•• EmancipateEmancipate

MirrorsMirrors

WindowsWindows

PuddlesPuddles

see, See, SEEsee, See, SEE

seesee

SeeSee

SEESEE

Poets SEE!Poets SEE!

po·etpo·et

•• A writer of poems or poetryA writer of poems or poetry•• One who is especially gifted in the One who is especially gifted in the

perception and expression of the beautiful perception and expression of the beautiful or lyricalor lyrical

•• One who composes in verse with meter, One who composes in verse with meter, melody or flowmelody or flow

po·et·rypo·et·ry

•• A quality that suggests grace, beauty, or A quality that suggests grace, beauty, or harmony harmony

BE a PoetBE a Poet

FLOW TrainingFLOW Training

Flow Training is a method of physical Flow Training is a method of physical performance enhancement applicable to performance enhancement applicable to all sports and general fitness. FT seeks to all sports and general fitness. FT seeks to maximize performance via techniques maximize performance via techniques derived from ancient Chinese and derived from ancient Chinese and Indonesian arts, as well as current Indonesian arts, as well as current methodologies. methodologies.

•• The fundamental premise of Flow Training is The fundamental premise of Flow Training is optimal performanceoptimal performance through through fluidityfluidity or or easeease of of movement which is movement which is inherentinherent in the in the neuromusculoskeletal systems of the body. FT neuromusculoskeletal systems of the body. FT develops flexibility, strength, power, accuracy, develops flexibility, strength, power, accuracy, coordination and concentration through training coordination and concentration through training attentionattention, , understandingunderstanding and and awarenessawareness. At the . At the same time, FT promotes same time, FT promotes appropriateappropriate and and intuitiveintuitive physical action whereby the body physical action whereby the body instantaneously processes instantaneously processes internalinternal and and external external feedbackfeedback resulting in performance through resulting in performance through awareness. awareness.

•• FT FT allowsallows movement rather than movement rather than directs directs movement. It enhances performance movement. It enhances performance through through easeease rather than rather than efforteffort. It . It promotes grace, fluidity and whippromotes grace, fluidity and whip--like like power by teaching how to power by teaching how to get out of your get out of your own wayown way and when to and when to don’tdon’t rather than rather than dodo. Flow Principles are what elite athletes . Flow Principles are what elite athletes and other elite movement artists have and other elite movement artists have mastered. Flow Training is a powerful tool mastered. Flow Training is a powerful tool toward that same mastery. toward that same mastery.

MASTERY

SKILL

ATTENTION UNDERSTANDING AWARENESS

KNOWLEDGECONCENTRATION APPRECIATION

EXPERIENCE

INFORMATION

OPPORTUNITY

DIRECTION SENSATION

Flow Training ObjectivesFlow Training Objectives•• InterveneIntervene

–– PainPain–– Imbalance Imbalance –– FearFear

•• EducateEducate–– Basic scienceBasic science

•• A & PA & P•• KinesiologyKinesiology•• Psychology Psychology

–– TechniqueTechnique•• DemonstrationDemonstration•• EmulationEmulation•• EvaluationEvaluation•• Integration Integration

•• InspireInspire–– A reason to be heardA reason to be heard–– A reason to devoteA reason to devote

Technique MethodologyTechnique Methodology

•• Neuromotor programmingNeuromotor programming–– DigitalDigital–– OverloadOverload–– PathPath–– Reflex managementReflex management

•• EmulationEmulation–– MasterMaster–– Reconstruct self (video)Reconstruct self (video)

Ecto Ecto –– Endo LoopEndo Loop•• All movement is in response to forces in the environmentAll movement is in response to forces in the environment•• Sensation is necessary for movementSensation is necessary for movement•• Sensation includes:Sensation includes:

–– 5 senses5 senses–– Muscle spindle, GTO, joint & tactile afferentsMuscle spindle, GTO, joint & tactile afferents–– SNS & ANSSNS & ANS

•• Sensation provide the mechanism for interpretation or Sensation provide the mechanism for interpretation or perceptionperception

•• Awareness is accurate perceptionAwareness is accurate perception•• Without awareness movement is inaccurate inefficient, Without awareness movement is inaccurate inefficient,

and dangerousand dangerous•• Movement with awareness optimizes performance and Movement with awareness optimizes performance and

avoids injuryavoids injury

Joints, Tendons, Ligaments, FasciaJoints, Tendons, Ligaments, Fascia

•• Awareness of involvement in movementAwareness of involvement in movement–– Martial arts, dance, gymnastics Martial arts, dance, gymnastics train train JTLFJTLF–– “springiness, suppleness, looseness“springiness, suppleness, looseness””

•• NonNon--contractile/elastic, Energy sparingcontractile/elastic, Energy sparing•• Support, control, assist movementSupport, control, assist movement•• Crucial role endoCrucial role endo--feedback feedback

Flow AxiomsFlow Axioms•• Master movement through Master movement through

understandingunderstanding, , attentionattention, , awarenessawarenessof of ectoecto--endo loopendo loop

•• Do less, Do less, Don’tDon’t moremore–– Stay out of your own wayStay out of your own way–– The more you don’t, the better you’ll doThe more you don’t, the better you’ll do

•• Seek Seek easeease not effortnot effort•• See, Listen, FeelSee, Listen, Feel•• Nature forms the standardNature forms the standard

StandardsStandards

•• PosturePosture•• Leaping, Landing, Leaping, Landing,

Cutting, Running(?)Cutting, Running(?)

•• RunningRunning

Posture as a StandardPosture as a Standard

Why have Standards?Why have Standards?

•• Maximize biomechanicsMaximize biomechanics–– Preserve joints through alignmentPreserve joints through alignment–– Enhance muscular capacityEnhance muscular capacity–– Avoid dangerous scenariosAvoid dangerous scenarios

•• Maximize performanceMaximize performance•• Prevent injuryPrevent injury•• Place to work from and towardPlace to work from and toward

Almost all athletes…Almost all athletes…

RUNRUN

All Pose slides taken from All Pose slides taken from www.posetech.comwww.posetech.com, Pose Method® of Running Book, , Pose Method® of Running Book, personal personal converstionconverstion..

Why Pose?Why Pose?

The Pose method is a simple and The Pose method is a simple and comprehensive biomechanical model comprehensive biomechanical model which eliminates injuries and enables which eliminates injuries and enables every runner from novice to elite to fully every runner from novice to elite to fully utilize their physiological potential.utilize their physiological potential.

Graham FletcherGraham Fletcher,,Former British triathlon National Team Coach Former British triathlon National Team Coach

•• Developed the Pose Developed the Pose Method® of Teaching Method® of Teaching Running Technique, in Running Technique, in Russia, in the 1970's Russia, in the 1970's

•• USA Triathlon Association USA Triathlon Association •• British Triathlon National British Triathlon National

TeamTeam•• Mexican National Mexican National

Triathlon TeamTriathlon Team•• Author, coach, instructor, Author, coach, instructor,

revolutionaryrevolutionary

WHAT IS POSE METHOD®? WHAT IS POSE METHOD®?

•• System for teaching of human movement System for teaching of human movement •• Key poses Key poses •• WithWith the laws of nature the laws of nature •• Gravity as the primary force for movementGravity as the primary force for movement•• NonNon--contractile, elastic properties of contractile, elastic properties of

tissuestissues•• Ground reaction force Ground reaction force

SHORT POSE CONCEPTSSHORT POSE CONCEPTS

•• POSEPOSE -- Most important position, it is position from which all Most important position, it is position from which all movement is generatedmovement is generated

•• WheelWheel -- Keeping the general center of mass (GMC) above the support Keeping the general center of mass (GMC) above the support point (midfoot) and pulling the ankle from the ground in a vertipoint (midfoot) and pulling the ankle from the ground in a vertical line cal line under the hips, in a continuous motion, like the wheel of a car.under the hips, in a continuous motion, like the wheel of a car.

•• SS--like Stancelike Stance Keeping the runner's body perfectly balanced on one leg, Keeping the runner's body perfectly balanced on one leg, with knee bent, making body compacted and loaded with elastic enwith knee bent, making body compacted and loaded with elastic energy ergy

•• Change of Support (CS)Change of Support (CS) -- Shifting the body mass from one leg to Shifting the body mass from one leg to another another

•• Vertical ActionVertical Action -- Pulling of the support foot from the ground up under the Pulling of the support foot from the ground up under the hip hip

•• Gratuitous ForcesGratuitous Forces --Gravity, elasticity, inertia, Coriolis; forces working Gravity, elasticity, inertia, Coriolis; forces working without ATP breakdown without ATP breakdown

••

Pose (Stance)Pose (Stance)

•• Running Pose:Running Pose: start with it in the static position , keeping your balance on start with it in the static position , keeping your balance on one leg, bent at the one leg, bent at the knee, with the body weight located on the knee, with the body weight located on the ball of the football of the foot. . (Drill 1. Pose Stance)(Drill 1. Pose Stance)

Keep the Pose for 4Keep the Pose for 4--5 seconds then change the support from one foot to the other. 5 seconds then change the support from one foot to the other. (Drill 4. Hop (Drill 4. Hop in Place)in Place) Repeat. Do 2Repeat. Do 2--3 sets of 103 sets of 10--15 reps of each drill to let your body "memorize" the pose. 15 reps of each drill to let your body "memorize" the pose.

Then incorporate it in a few short (30Then incorporate it in a few short (30--50 meters) runs at any comfortable for you speed. 50 meters) runs at any comfortable for you speed.

•• Keep your hips above the ball of your foot.Keep your hips above the ball of your foot.

•• The most difficult thing to learn is to get a proper perception The most difficult thing to learn is to get a proper perception of holding the body weight on the of holding the body weight on the ball of the football of the foot. .

•• Barefoot to get even more precise perception of being on the Barefoot to get even more precise perception of being on the ball of the football of the foot. .

•• Stance knee ALWAYS in flexionStance knee ALWAYS in flexion

FallFall

•• Falling is a psychological "action" of allowing Falling is a psychological "action" of allowing yourself to fall forward, but not your muscular yourself to fall forward, but not your muscular efforts. efforts. (("Pose Method" book"Pose Method" book, Fig. 23.2, Fig. 23.2--23.3, 23.3, p.118p.118--119)119)

•• Lean your body from the ankles. Leaning is a Lean your body from the ankles. Leaning is a rotational movement of the body where the foot rotational movement of the body where the foot is the pivotal point of rotation. is the pivotal point of rotation.

PullPull

•• Pulling is very difficult, not physically but Pulling is very difficult, not physically but psychologically, because it goes against psychologically, because it goes against your paradigm and habits of running.your paradigm and habits of running.

•• Give up pushing off from the ground Give up pushing off from the ground •• Develop action of hamstrings pulling foot Develop action of hamstrings pulling foot

under hipunder hip•• Minimal time in stance phaseMinimal time in stance phase

Pose MethodPose Method

•• Understand biomechanicsUnderstand biomechanics•• Develop Develop sensibility sensibility through drillsthrough drills•• Integrate sensibility into runningIntegrate sensibility into running

Pose for ACL (all) Injury PreventionPose for ACL (all) Injury Prevention

•• Knee always flexed in stanceKnee always flexed in stance•• Stance phase absolutely minimizedStance phase absolutely minimized•• GCM over feetGCM over feet•• Optimal management GRFOptimal management GRF•• Sensibility through awarenessSensibility through awareness

Pose as the FoundationPose as the Foundation

Poetry

ProtocolBased

Programs

The Pose Method of Running

Poetry In MotionPoetry In Motion

To BE or not to beTo BE or not to beIS the questionIS the question

BEBE

Injury FreeInjury Free